Frontiers in Oncology (Aug 2021)

Is Adjuvant Chemotherapy Beneficial to All Patients With pT3N0M0 Stage Gastric Cancer?

  • Jiao-Bao Huang,
  • Jiao-Bao Huang,
  • Jiao-Bao Huang,
  • Jun Lu,
  • Jun Lu,
  • Jun Lu,
  • Dong Wu,
  • Dong Wu,
  • Dong Wu,
  • Bin-bin Xu,
  • Bin-bin Xu,
  • Bin-bin Xu,
  • Zhen Xue,
  • Zhen Xue,
  • Zhen Xue,
  • Guo-Sheng Lin,
  • Guo-Sheng Lin,
  • Guo-Sheng Lin,
  • Hua-Long Zheng,
  • Hua-Long Zheng,
  • Hua-Long Zheng,
  • Li-li Shen,
  • Li-li Shen,
  • Li-li Shen,
  • Jia Lin,
  • Jia Lin,
  • Jia Lin,
  • Jian-Wei Xie,
  • Jian-Wei Xie,
  • Jian-Wei Xie,
  • Jia-Bin Wang,
  • Jia-Bin Wang,
  • Jia-Bin Wang,
  • Jian-Xian Lin,
  • Jian-Xian Lin,
  • Jian-Xian Lin,
  • Qi-Yue Chen,
  • Qi-Yue Chen,
  • Qi-Yue Chen,
  • Long-Long Cao,
  • Long-Long Cao,
  • Long-Long Cao,
  • Chao-Hui Zheng,
  • Chao-Hui Zheng,
  • Chao-Hui Zheng,
  • Chang-Ming Huang,
  • Chang-Ming Huang,
  • Chang-Ming Huang,
  • Ping Li,
  • Ping Li,
  • Ping Li

DOI
https://doi.org/10.3389/fonc.2021.712432
Journal volume & issue
Vol. 11

Abstract

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BackgroundThe efficacy and benefits of adjuvant chemotherapy (AC) for patients with gastric cancer pT3N0M0 remain controversial.MethodsWe prospectively collected and retrospectively analyzed 235 patients with pT3N0M0 gastric cancer who underwent radical resection between February 2010 and January 2016. Patients were divided into two groups: the surgery-alone (SA) group (n = 82) and the AC group (n = 153). We analyzed the effects of AC on the overall survival (OS) and recurrence-free survival (RFS), and the relationship between the number of chemotherapy cycles (CC) and recurrence rate (RR).ResultsThe 5-year OS and RFS of the participants were 80.9% and 87.7%, respectively, and those in the AC group were significantly higher than those in the SA group (86.9% vs. 69.5%, p = 0.003). The RFS of the AC and SA groups were 88.9% and 85.4%, respectively; the difference was not statistically significant (p = 0.35). The independent risk factors affecting the OS were perineural invasion-positive (PNI+) (HR = 2.64, 95%CI: 1.45–4.82, p = 0.003) and age ≥ 65 years (HR = 2.58, 95%CI: 1.39–4.8, p = 0.003). The independent risk factor affecting the RFS was also PNI+ (HR3.11; 95%CI: 1.48–6.54, p = 0.003). Stratified analysis revealed that postoperative AC can significantly improve the OS of PNI+ patients (AC group versus SA group: 84.1% vs. 45.5%, p = 0.001) and RFS (86.4% vs. 63.6%, p = 0.017). However, perineural invasion negative (PNI-) patients did not show the same results (p = 0.13 and p = 0.48, respectively). According to the number of CC, divided into CC < 3 groups and CC ≥ 3 groups, the cumulative RR in the CC ≥ 3 group of patients with PNI+ was significantly lower than that of the CC < 3 group (7.4% vs. 28.2%, p = 0.037).ConclusionFor pT3N0M0 gastric cancer patients with PNI+, at least three cycles of postoperative AC can significantly reduce the overall RR. This finding should be verified by using large external sample data.

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