Li YF, Zhang WB, Gao YY. Prognostic effect of excessive chemotherapy cycles for stage II and III gastric cancer patients after D2 + gastrectomy. World J Gastrointest Surg 2023; 15(1): 32-48 [PMID: 36741062 DOI: 10.4240/wjgs.v15.i1.32]
Corresponding Author of This Article
Wen-Bing Zhang, MD, Chief Doctor, Surgeon, Endoscopy Center, Shanxi Province Cancer Hospital, No. 3 Xinghualing District, Staff New Village, Taiyuan 030013, Shanxi Province, China. lyf8028@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Jan 27, 2023; 15(1): 32-48 Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.32
Table 1 Patient characteristics before and after propensity score matching based on the number of chemotherapy cycles for stage II gastric cancer
Variables
Before PSM
P value
After PSM
P value
< 9 cycles, n = 125
≥ 9 cycles, n = 287
< 9 cycles, n = 97
≥ 9 cycles, n = 97
Sex
0.022
0.718
Male
95
245
77
79
Female
30
42
20
18
Age in yr
55.38 ± 10.91
60.44 ± 9.85
< 0.001
56.46 ± 10.10
56.46 ± 10.10
0.215
Depth of tumor invasion
0.248
0.998
T1
7
6
5
4
T2
11
18
10
10
T3
79
195
60
62
T4
28
68
22
21
Number of positive lymph nodes
0.064
0.740
0
64
172
52
49
1-2
53
107
39
43
3-6
4
5
4
3
≥ 7
4
3
2
2
Type of gastrectomy
0.448
0.249
Proximal
14
24
10
8
Distal
41
93
32
26
Total
0
170
55
63
Vascular invasion
0.561
0.468
Negative
77
168
54
59
Positive
48
119
42
38
Neural invasion
0.719
1.000
Negative
79
176
64
64
Positive
46
111
33
33
Lauren classification
0.793
0.493
Intestinal
60
143
47
52
Diffuse
27
58
21
19
Mixed
38
86
29
26
Maximum diameter of tumor in cm
0.603
0.410
< 6
87
207
70
75
≥ 6
38
80
27
22
Surgical margin
0.740
0.562
Negative
123
281
95
96
Positive
2
6
2
2
HER2
0.337
0.911
Negative
70
171
55
54
Positive
55
116
42
43
Table 2 Subgroup analysis of overall survival by Cox regression analysis of stage II gastric cancer patients
Variables
Death
Total
HR
95%CI
P value
P for interaction
Sex
0.219
Male
33
156
0.966
0.486-1.919
0.922
Female
6
38
0.520
0.095-2.852
0.452
Depth of tumor invasion
0.749
T1/T2
7
29
0.745
0.164-3.382
0.702
T3/T4
32
165
0.908
0.451-1.828
0.786
Number of positive lymph nodes
0.458
0
21
101
0.584
0.236-1.450
0.247
≥ 1
18
93
1.254
0.492-3.194
0.635
Vascular invasion
0.729
Negative
24
128
1.474
0.535-4.061
0.431
Positive
15
66
0.679
0.246-1.870
0.453
Neural invasion
0.937
Negative
36
163
1.035
0.465-2.306
0.932
Positive
22
93
0.709
0.241-2.083
0.531
Lauren classification
0.553
Intestinal
16
99
0.931
0.568-1.526
0.766
Diffuse
11
40
0.755
0.228-2.506
0.647
Mixed
12
55
1.014
0.570-1.802
0.963
Maximum diameter of tumor in cm
0.167
< 6
20
145
0.986
0.410-2.375
0.976
≥ 6
19
49
0.807
0.317-2.054
0.653
Type of gastrectomy
0.664
Proximal
4
18
1.029
0.378-2.804
Distal
9
58
1.103
0.296-4.111
Total
26
118
0.850
0.575-1.256
HER2
0.656
Negative
21
109
0.858
0.361-2.040
Positive
18
85
0.869
0.343-2.204
Table 3 Subgroup analysis of progression-free survival by Cox regression analysis of chemotherapy cycles of stage II gastric cancer
Variables
Death or recurrence
Total
HR
95%CI
P value
P for interaction
Sex
0.385
Male
33
156
0.788
0.426-1.459
0.449
Female
22
38
0.495
0.149-1.646
0.252
Depth of tumor invasion
0.226
T1/T2
9
29
0.827
0.227-3.109
0.779
T3/T4
46
165
0.670
0.368-1.219
0.190
Number of positive lymph nodes
0.842
0
28
101
0.519
0.232-1.159
0.110
≥ 1
27
93
0.895
0.420-1.905
0.773
Vascular invasion
0.743
Negative
23
128
1.225
0.536-1.798
0.630
Positive
32
66
0.454
0.200-0.988
0.047
Neural invasion
0.732
Negative
35
163
0.649
0.328-1.286
0.216
Positive
20
93
0.878
0.348-2.212
0.782
Lauren classification
0.622
Intestinal
20
99
0.833
0.344-2.015
0.685
Diffuse
15
40
0.582
0.207-1.639
0.306
Mixed
20
55
0.839
0.323-2.177
0.718
Maximum diameter of tumor in (cm)
0.128
< 6
33
145
0.642
0.317-1.301
0.219
≥ 6
22
49
0.883
0.370-2.106
0.779
Type of gastrectomy
0.356
Proximal
5
18
0.716
0.115-4.443
0.720
Distal
17
58
0.521
0.181-1.501
0.227
Total
35
118
0.779
0.389-1.503
0.483
HER2
0.200
Negative
29
109
0.851
0.408-1.772
0.665
Positive
26
85
0.549
0.242-1.245
0.151
Table 4 Patient characteristics before and after propensity score matching based on the number of chemotherapy cycles for stage III gastric cancer
Variables
Before PSM
P value
After PSM
P value
< 9 cycles, n = 278
≥ 9 cycles, n = 624
< 9 cycles, n = 242
≥ 9 cycles, n = 242
Sex
0.082
0.298
Male
207
497
185
175
Female
71
127
57
67
Age in yr
56.97 ± 9.85
59.91 ± 10.03
< 0.001
57.35 ± 9.31
58.01 ± 9.17
0.418
Depth of tumor invasion
0.568
0.754
T2
1
1
0
0
T3
72
152
60
63
T4
205
471
182
179
Number of positive lymph nodes
0.110
0.756
0
0
4
0
0
1-2
39
111
36
34
3-6
68
155
60
67
≥ 7
171
354
146
141
Type of gastrectomy
0.044
0.903
Proximal
16
36
13
12
Distal
89
154
71
71
Total
173
454
158
159
Vascular invasion
0.852
0.916
Negative
67
154
59
60
Positive
211
470
183
182
Neural invasion
0.156
0.288
Negative
85
211
74
85
Positive
193
403
168
157
Lauren classification
0.664
0.597
Intestinal
52
125
46
42
Diffuse
153
315
127
127
Mixed
73
184
69
73
Maximum diameter of tumor in cm
0.346
0.467
< 6
134
322
119
111
≥ 6
144
302
123
131
Surgical margin
0.571
0.254
Negative
260
577
225
218
Positive
18
47
17
24
Table 5 Subgroup analysis of overall survival by Cox regression analysis of stage III gastric cancer patients
Variables
Death
Total
HR
95%CI
P value
P for interaction
Sex
0.639
Male
198
360
1.258
0.951-1.664
0.108
Female
72
124
0.925
0.582-1.470
0.741
Depth of tumor invasion
0.127
T3
43
123
1.044
0.569-1.916
0.888
T4
227
361
1.207
0.929-1.567
0.158
Number of positive lymph nodes
0.007
≤ 6
91
197
1.312
0.867-1.988
0.199
≥ 7
179
287
1.115
0.832-1.496
0.466
Vascular invasion
0.099
Negative
58
119
1.365
0.818-2.277
0.233
Positive
211
365
1.138
0.868-1.492
0.350
Neural invasion
0.059
Negative
73
159
1.389
0.872-2.211
0.166
Positive
197
325
1.114
0.842-1.474
0.451
Lauren classification
0.002
Intestinal
39
88
1.196
0.873-1.640
0.264
Diffuse
168
254
1.184
0.872-1.606
0.280
Mixed
63
142
0.975
0.760-1.250
0.840
Maximum diameter of tumor in cm
< 0.001
< 6
108
230
1.071
0.734-1.563
0.722
≥ 6
162
254
1.240
0.909-1.692
0.174
Type of gastrectomy
0.004
Proximal
13
25
1.175
0.680-2.032
0.564
Distal
65
142
0.915
0.560-1.494
0.722
Total
192
317
1.125
0.976-1.297
0.105
Table 6 Subgroup analysis of progression-free survival by Cox regression analysis of stage III gastric cancer patients
Variables
Death or recurrence
Total
HR
95%CI
P value
P for interaction
Sex
0.418
Male
227
360
0.925
0.712-1.200
0.555
Female
88
124
0.555
0.363-0.846
0.006
Depth of tumor invasion
0.266
T3
65
123
0.719
0.438-1.181
0.193
T4
250
361
0.813
0.649-1.066
0.145
Number of positive lymph nodes
0.170
≤ 6
108
197
0.933
0.640-1.361
0.719
≥ 7
207
287
0.753
0.572-0.990
0.042
Vascular invasion
0.382
Negative
72
119
0.824
0.518-1.311
0.414
Positive
243
365
0.829
0.644-1.068
0.147
Neural invasion
0.469
Negative
92
159
0.961
0.638-1.449
0.851
Positive
223
325
0.773
0.593-1.007
0.056
Lauren classification
0.083
Intestinal
47
88
0.886
0.498-1.576
0.632
Diffuse
193
254
0.923
0.695-1.227
0.042
Mixed
75
142
0.576
0.365-0.910
0.406
Maximum diameter of tumor in cm
0.236
< 6
132
230
0.765
0.543-1.078
0.126
≥ 6
183
254
0.850
0.636-1.136
0.271
Type of gastrectomy
0.605
Proximal
15
25
0.781
0.282-2.162
0.635
Distal
82
142
0.761
0.490-1.181
0.223
Total
218
317
0.830
0.636-1.083
0.169
Citation: Li YF, Zhang WB, Gao YY. Prognostic effect of excessive chemotherapy cycles for stage II and III gastric cancer patients after D2 + gastrectomy. World J Gastrointest Surg 2023; 15(1): 32-48