PMID- 28513823
OWN - NLM
STAT- MEDLINE
DCOM- 20171004
LR  - 20171004
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
VI  - 123
IP  - 17
DP  - 2017 Sep 1
TI  - Adjuvant radiotherapy improves overall survival in patients with resected gastric
      adenocarcinoma: A National Cancer Data Base analysis.
PG  - 3402-3409
LID - 10.1002/cncr.30748 [doi]
AB  - BACKGROUND: For patients with resectable gastric adenocarcinoma, perioperative
      chemotherapy and adjuvant chemoradiotherapy (CRT) are considered standard
      options. In the current study, the authors used the National Cancer Data Base to 
      compare overall survival (OS) between these regimens. METHODS: Patients who
      underwent gastrectomy for nonmetastatic gastric adenocarcinoma from 2004 through 
      2012 were divided into those treated with perioperative chemotherapy without RT
      versus those treated with adjuvant CRT. Survival was estimated and compared using
      univariate and multivariate models adjusted for patient and tumor
      characteristics, surgical margin status, and the number of lymph nodes examined. 
      Subset analyses were performed for factors chosen a priori, and potential
      interactions between treatment and covariates were assessed. RESULTS: A total of 
      3656 eligible patients were identified, 52% of whom underwent perioperative
      chemotherapy and 48% of whom received postoperative CRT. The median follow-up was
      47 months, and the median age of the patients was 62 years. Analysis of the
      entire cohort demonstrated improved OS with adjuvant RT on both univariate
      (median of 51 months vs 42 months; P = .013) and multivariate (hazard ratio,
      0.874; 95% confidence interval, 0.790-0.967 [P = .009]) analyses. Propensity
      score-matched analysis also demonstrated improved OS with adjuvant RT (median of 
      49 months vs 39 months; P = .033). On subset analysis, a significant interaction 
      was observed between the survival impact of adjuvant RT and surgical margins,
      with a greater benefit of RT noted among patients with surgical margin-positive
      disease (hazard ratio with RT: 0.650 vs 0.952; P for interaction <.001).
      CONCLUSIONS: In this National Cancer Data Base analysis, the use of adjuvant RT
      in addition to chemotherapy was associated with a significant OS advantage for
      patients with resected gastric cancer. The survival advantage observed with
      adjuvant CRT was most pronounced among patients with positive surgical margins.
      Cancer 2017;123:3402-9. (c) 2017 American Cancer Society.
CI  - (c) 2017 American Cancer Society.
FAU - Stumpf, Priscilla K
AU  - Stumpf PK
AUID- ORCID: http://orcid.org/0000-0002-7965-3455
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
FAU - Amini, Arya
AU  - Amini A
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
FAU - Jones, Bernard L
AU  - Jones BL
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
FAU - Koshy, Matthew
AU  - Koshy M
AD  - Department of Radiation Oncology, University of Illinois at Chicago School of
      Medicine, Chicago, Illinois.
FAU - Sher, David J
AU  - Sher DJ
AD  - Radiation Oncology, Department of Clinical Science, University of Texas
      Southwestern Medical Center, Dallas, Texas.
FAU - Lieu, Christopher H
AU  - Lieu CH
AD  - Department of Medical Oncology, University of Colorado Cancer Center, University 
      of Colorado School of Medicine, Aurora, Colorado.
FAU - Schefter, Tracey E
AU  - Schefter TE
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
FAU - Goodman, Karyn A
AU  - Goodman KA
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
FAU - Rusthoven, Chad G
AU  - Rusthoven CG
AD  - Department of Radiation Oncology, University of Colorado Cancer Center,
      University of Colorado School of Medicine, Aurora, Colorado.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170517
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
RN  - 0 (Antineoplastic Agents)
SB  - AIM
SB  - IM
MH  - Adenocarcinoma/*mortality/pathology/*radiotherapy/surgery
MH  - Adult
MH  - Aged
MH  - Analysis of Variance
MH  - Antineoplastic Agents/administration & dosage
MH  - Databases, Factual
MH  - Disease-Free Survival
MH  - Female
MH  - Gastrectomy/methods
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Neoadjuvant Therapy
MH  - Neoplasm Invasiveness/pathology
MH  - Neoplasm Staging
MH  - Preoperative Care
MH  - Prognosis
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Radiotherapy, Adjuvant
MH  - Retrospective Studies
MH  - Stomach Neoplasms/*mortality/*pathology/*radiotherapy/surgery
MH  - Survival Analysis
MH  - Treatment Outcome
OTO - NOTNLM
OT  - adenocarcinoma
OT  - chemoradiotherapy (CRT)
OT  - conformal radiotherapy
OT  - gastrectomy
OT  - stomach
EDAT- 2017/05/18 06:00
MHDA- 2017/10/05 06:00
CRDT- 2017/05/18 06:00
PHST- 2017/01/27 00:00 [received]
PHST- 2017/03/08 00:00 [revised]
PHST- 2017/03/28 00:00 [accepted]
PHST- 2017/05/18 06:00 [pubmed]
PHST- 2017/10/05 06:00 [medline]
PHST- 2017/05/18 06:00 [entrez]
AID - 10.1002/cncr.30748 [doi]
PST - ppublish
SO  - Cancer. 2017 Sep 1;123(17):3402-3409. doi: 10.1002/cncr.30748. Epub 2017 May 17.