Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1222-1233
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1222
Survival in gastric cancer in relation to postoperative adjuvant therapy and determinants
Sevgi Ozden, Zerrin Ozgen, Hazan Ozyurt, Cengiz Gemici, Gokhan Yaprak, Huseyin Tepetam, Alpaslan Mayadagli
Sevgi Ozden, Zerrin Ozgen, Hazan Ozyurt, Cengiz Gemici, Gokhan Yaprak, Huseyin Tepetam, Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, 34890 Istanbul, Turkey
Alpaslan Mayadagli, Faculty of Medicine, Bezmialem Vakif University, 34093 Istanbul, Turkey
Author contributions: Ozden S designed and performed the research, analyzed the data; Ozden S, Ozyurt H and Ozgen Z performed drafting the article or revising it critically for important intellectual content; Gemici C, Yaprak G and Tepetam H contributed to the treatment and follow up of patients; Mayadagli A was the director of the department at that time of patients’ treatment and follow up; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sevgi Ozden, MD, PhD, Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Cevizli-Kartal-Istanbul, 34890 Istanbul, Turkey. sevgiozden@gmail.com
Telephone: +90-216-4413900 Fax: +90-216-3520083
Received: May 23, 2014
Peer-review started: May 26, 2014
First decision: July 9, 2014
Revised: August 16, 2014
Accepted: October 15, 2014
Article in press: October 15, 2014
Published online: January 28, 2015
Processing time: 248 Days and 22.4 Hours
Abstract

AIM: To evaluate survival data in patients with gastric cancer in relation to postoperative adjuvant therapy and survival determinants

METHODS: A total of 201 patients (mean ± SD age: 56.0 ± 11.9 years, 69.7% were males) with gastric carcinoma who were operated and followed up at Lutfi Kirdar Kartal Training and Research Hospital between 1998 and 2010 were included in this retrospective study. Follow up was evaluated divided into two consecutive periods (before 2008 and 2008-2010, respectively) based on introduction of 3-D conformal technique in radiotherapy at our clinic in 2008. Data on patient demographics, clinical and histopathological characteristics of gastric carcinoma and the type of treatment applied after surgery [postoperative adjuvant treatment protocols including chemoradiotherapy (CRT) and chemotherapy (CT), supportive therapy or follow up without any treatment] were recorded. The median duration and determinants of local recurrence free (LRF) survival, distant metastasis free (DMF) survival and overall survival were evaluated in the overall population as well as with respect to follow up years [1998-2008 (n = 127) vs 2008-2010 (n = 74)].

RESULTS: Median duration for LRF survival, DMF survival and overall survival were 31.9, 24.1 and 31.9 mo, respectively in patients with postoperative adjuvant CRT. No significant difference was noted in median duration for LRF survival, DMF survival and overall survival with respect to treatment protocols in the overall population and also with respect to followed up periods. In the overall population, CT protocols FUFA [5-fluorouracil (400 mg/m2) and leucovorin-folinic acid (FA, 20 mg/m2)] (29.9 mo) and UFT® + Antrex® [a fixed combination of the oral FU prodrug tegafur (flouroprymidine, FT, 300 mg/m2 per day) with FA (Antrex®), 15 mg tablet, two times a day] (42.5 mo) was significantly associated with longer LRF survival times than other CT protocols (P = 0.036), while no difference was noted between CT protocols in terms of DMF survival and overall survival. Among patients received CRT, overall survival was significantly longer in patients with negative than positive surgical margin (27.7 mo vs 22.4 mo, P = 0.016) in the overall study population, while time of radiotherapy initiation had no significant impact on survival times. Nodal stage was determined to be independent predictor of LRF survival in the overall study population with 4.959 fold (P = 0.042) increase in mortality in patients with nodal stage N2 compared to patients with nodal stage N0, and independent predictor of overall survival with 5.132 fold (P = 0.006), 5.263 fold (P = 0.027) and 4.056 fold (P = 0.009) increase in the mortality in patients with nodal stage N3a (before 2008), N3b (before 2008) and N2 (overall study population) when compared to patients with N0 stage, respectively.

CONCLUSION: Our findings emphasize the likelihood of postoperative adjuvant CRT to have a survival benefit in patients with resectable gastric carcinoma.

Keywords: Gastric carcinoma; Local recurrence free survival; Distant metastasis free survival; Postoperative adjuvant therapy; Overall survival

Core tip: This retrospective single centre analysis of survival data in patients with resected gastric carcinoma revealed median 31.9 mo of local recurrence free (LRF) survival, 24.1 mo of distant metastasis free survival and 31.9 mo of overall survival via postoperative adjuvant chemoradiotherapy during follow up from 1998 to 2010. Use of 5-fluorouracil and leucovorin-folinic acid and uracil/tegafur based chemotherapy protocols and the absence of positive surgical margin but not the interval between surgery and radiotherapy had a significant impact on survival times, while the nodal stage was the independent prognostic factor for LRF and overall survival.