Adjuvant Chemotherapy Might Be Recommended to Patients With Positive Margin After Gastrectomy: A 20-Year Retrospective Analysis in a Single Center

Xiaojie Zhang; Lulu Zhao; Penghui Niu; Tongbo Wang; Wanqing Wang; Chongyuan Sun; Zefeng Li; Yingtai Chen; Dongbing Zhao

doi:10.3389/fonc.2021.794032

Adjuvant Chemotherapy Might Be Recommended to Patients With Positive Margin After Gastrectomy: A 20-Year Retrospective Analysis in a Single Center

Front Oncol. 2022 Feb 2:11:794032. doi: 10.3389/fonc.2021.794032. eCollection 2021.

Authors

Xiaojie Zhang¹, Lulu Zhao¹, Penghui Niu¹, Tongbo Wang¹, Wanqing Wang¹, Chongyuan Sun¹, Zefeng Li¹, Yingtai Chen¹, Dongbing Zhao¹

Affiliation

¹ Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: Margin positivity after gastric cancer resection is associated with poorer outcomes. However, the prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated.

Methods: A single-center, retrospective analysis was conducted for patients with PM after gastrectomy from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS).

Results: A total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM), 205 (45.7%) in the distal PM group (DPM), and 52 (11.6%) in the bilateral PM group (BPM). The 3- and 5-year OS rates for the PM patients investigated were 47.5% and 39.3%, respectively, and the 3- and 5-year RFS rates were 60.0% and 53.6%, respectively. Multivariate Cox regression analysis proved total gastrectomy (hazard ratio (HR): 1.783, 95%CI: 1.133-2.805, p = 0.012), pT4 (HR: 5.264, 95%CI: 1.493-18.565, p = 0.01), pN2 (HR: 2.263, 95%CI: 1.164-4.397, p = 0.016), pN3 (HR: 2.327, 95%CI: 1.233-4.393, p = 0.009), and combined resection (HR: 1.952, 95%CI: 1.256-3.034, p = 0.003) to be independent risk factors of OS, and pT3 (HR: 9.257, 95%CI: 1.152-74.386, p = 0.036) and pT4 (HR: 11.361, 95%CI: 1.469-87.847, p = 0.020) to be independent risk factors for RFS. Adjuvant chemotherapy prolonged OS in the PPM group (p = 0.032) and prolonged RFS in the PPM group (p < 0.001) and the DPM group (p = 0.035) compared with surgery alone.

Conclusions: Advanced pathologic stage was associated with poor prognosis, and postoperative adjuvant chemotherapy might be recommended in PM patients after gastrectomy. Still, further prospective trials are warranted to verify and support our conclusions.

Keywords: adjuvant chemotherapy; gastrectomy; gastric cancer; positive margin; prognosis.