Purpose: Whether adjuvant chemotherapy (AC) has a survival benefit for all patients with pathological stage pT1N1M0 (Stage IB) gastric cancer (GC) remains controversial.
Methods: All patients with surgically resected, histologically confirmed pT1N1M0 GC between January 2011 and December 2017 at the National Cancer Center, China, were retrospectively reviewed.
Results: A total of 179 patients with pT1N1M0 were identified. Survival analysis showed that both overall survival (OS) and cause-specific survival (CSS) were significantly different between patients treated with and without AC (p < 0.01). Independent risk factors for reduced OS identified in the Cox regression analysis in patients with pT1N1M0 cancer were sex (male sex, hazard ratio [HR] 2.470, 95% confidence interval [CI] 1.294-4.718), examined lymph nodes (EN) (EN ≤ 15, HR 2.402; 95% CI 1.329-4.341), and AC (treated without AC, HR 2.554; 95% CI 1.393-4.681), which were also independent risk factors for reduced CSS. We divided patients with pT1N1M0 into three risk categories (high, moderate, and low) according to two significant prognostic factors (sex and EN) and found that both OS and CSS were significantly different between the three risk groups (p < 0.05).
Conclusion: An additional survival benefit related to AC is expected for selected pT1N1M0 patients. Male patients with EN ≤ 15 may be particularly appropriate candidates for AC.
Keywords: Adjuvant chemotherapy; Gastric cancer; Prognosis; T1N1M0.