Implications of Lymph Node Staging on Selection of Adjuvant Therapy for Gastric Cancer in the United States: A Propensity Score-matched Analysis

Datta, Jashodeep MD; McMillan, Matthew T. BA; Ecker, Brett L. MD; Karakousis, Giorgos C. MD; Mamtani, Ronac MD, MSCE; Plastaras, John P. MD, PhD; Giantonio, Bruce J. MD; Drebin, Jeffrey A. MD, PhD; Dempsey, Daniel T. MD, MBA; Fraker, Douglas L. MD; Roses, Robert E. MD

Annals of Surgery: February 2016 - Volume 263 - Issue 2 - p 298–305

doi: 10.1097/SLA.0000000000001360

Original Articles

Objective: To compare the efficacy of adjuvant chemoradiotherapy (CRT) and chemotherapy alone (CA) in gastric adenocarcinoma patients undergoing gastrectomy in the United States (US).

Background: A majority of US gastric adenocarcinoma patients are inadequately staged (<15 nodes examined). Despite this, and limited data comparing adjuvant CRT with CA in US patients, national guidelines endorse CA in selected patients undergoing D2 lymphadenectomy.

Methods: Resected stage IB-III gastric adenocarcinoma patients receiving adjuvant CRT or CA (n = 3008) were identified in the National Cancer Database (1998–2006). Cox regression identified covariates associated with overall survival (OS). CRT and CA cohorts were matched (3:1) by propensity scores based on the likelihood of receiving CA. OS was compared by Kaplan-Meier estimates.

Results: Adjuvant CA was associated with an increased risk of death (HR 1.29, P < 0.001) relative to CRT. Inadequate lymph node staging (LNS) and nodal positivity were strong predictors of risk-adjusted mortality (P < 0.001). After propensity score-matching, CRT demonstrated superior median OS compared with CA (36.1 vs 28.9 m; P < 0.0001), regardless of stage. CRT was superior to CA in inadequately staged patients (33.1 m vs 24.5 m; P < 0.001); this benefit was less pronounced with increasing nodal examination. CRT improved OS in node-positive disease (29.8 vs 22.2 m; P < 0.001), regardless of LNS adequacy. In node-negative disease, OS did not differ significantly between CRT and CA cohorts; however, node-negative patients undergoing inadequate LNS benefited from CRT.

Conclusions: CRT is associated with improved stage-stratified OS compared with CA. Lymph node status and adequacy of surgical staging should influence adjuvant therapy selection in the United States.

http://journals.lww.com/annalsofsurgery/Abstract/2016/02000/Implications_of_Lymph_Node_Staging_on_Selection_of.17.aspx

Pretreatment Neutrophil to Lymphocyte Ratio Independently Predicts Disease-specific Survival in Resectable Gastroesophageal Junction and Gastric Adenocarcinoma

Wang, Sam C. MD; Chou, Joanne F. MPH; Strong, Vivian E. MD; Brennan, Murray F. MD; Capanu, Marinela PhD; Coit, Daniel G. MD

Annals of Surgery: February 2016 - Volume 263 - Issue 2 - p 292–297

doi: 10.1097/SLA.0000000000001189

Original Articles

Objective: Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR).

Background: The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes.

Conclusions: In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.

http://journals.lww.com/annalsofsurgery/Abstract/2016/02000/Pretreatment_Neutrophil_to_Lymphocyte_Ratio.16.aspx