Does non‐metastatic gastric cancer of the cardia warrant a different treatment strategy?

Author:

Ajay Pranay S.1ORCID,NeMoyer Rachel2,Goyal Subir3,Switchenko Jeffery M.3,Lin Yong4,Jabbour Salma K.5,Carpizo Darren R.6,Paulos Chrystal M.7,Kennedy Timothy J.8,Shah Mihir M.7ORCID

Affiliation:

1. Division of Surgical Oncology Emory University School of Medicine Atlanta Georgia USA

2. Division of Thoracic and Cardiothoracic Surgery Cleveland Clinic Foundation Cleveland Ohio USA

3. Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University Atlanta Georgia USA

4. Department of Biostatistics and Epidemiology, Rutgers School of Public Health Rutgers University New Brunswick New Jersey USA

5. Division of Radiation Oncology, Rutgers Cancer Institute of New Jersey Rutgers University New Brunswick New Jersey USA

6. Division of Surgical Oncology, Wilmot Cancer Institute University of Rochester Rochester New York USA

7. Division of Surgical Oncology, Winship Cancer Institute Emory University Atlanta Georgia USA

8. Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey Rutgers University New Brunswick New Jersey USA

Abstract

AbstractBackgroundMultimodal treatment strategies with surgery as its centerpiece have been accepted as the standard of care in nonmetastatic cardia gastric cancer (CGC). There remains a lack of consensus regarding the optimal multimodal treatment strategy.MethodWe queried National Cancer Database from 2004 to 2016 to identify patients with resected nonmetastatic CGC who received perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), or postoperative chemotherapy (POC). A subgroup analysis was performed in optimally treated patients defined as initial chemotherapy within 45 days of diagnosis, resection within 45 days of diagnosis, negative margins, adjuvant chemotherapy within 90 days of resection, and standard radiation dose (45 Gy). Kaplan–Meier, Univariate analysis (UVA), and Multivariable analysis (MVA) were performed.ResultsWe identified 2387 patients. Median survival was 38.8 months in the PEC group, 36 months in the POCR group, and 32.3 months in the POC group (p = 0.1025). On UVA, patients treated with PEC had an association with improved survival (HR, 0.83; p = 0.037) when compared with POC. On MVA, no significant difference was noted in overall survival (OS) between PEC, POCR, and POC, similar to subgroup analysis of optimally treated cohort.ConclusionOS rate in nonmetastatic CGC is not significantly different between patients receiving PEC, POCR, or POC.

Publisher

Wiley

Subject

Oncology,General Medicine,Surgery

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