Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer

Georgios Karagkounis, Malcolm Hart Squires, Marcovalerio Melis, George A. Poultsides, David Worhunsky, Linda X. Jin, Ryan C. Fields, Gaya Spolverato, Timothy M. Pawlik, Konstantinos I. Votanopoulos, Edward A. Levine, Carl Schmidt, Mark Bloomston, Clifford S. Cho, Sharon Weber, Antonio Masi, Russell Berman, H. Leon Pachter, Charles A. Staley, Elliot NewmanShishir K. Maithel, Ioannis Hatzaras

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Perioperative chemotherapy in gastric cancer is increasingly used since the “MAGIC” trial, while clinical practice data outside of trials remain limited. We sought to evaluate the predictors and prognostic implications of perioperative chemotherapy completion in patients undergoing curative-intent gastrectomy across multiple US institutions. Methods: Patients who underwent curative-intent resection of gastric adenocarcinoma between 2000 and 2012 in eight institutions of the US Gastric Cancer Collaborative were identified. Patients who received preoperative chemotherapy were included, while those who died within 90 days or with unknown adjuvant chemotherapy status were excluded. Predictors of chemotherapy completion and survival were identified using multivariable logistic regression and Cox proportional hazards. Results: One hundred sixty three patients were included (median age 63.3, 36.8% female). The postoperative component of perioperative chemotherapy was administered in 112 (68.7%) patients. Factors independently associated with receipt of adjuvant chemotherapy were younger age (odds ratio (OR) 2.73, P = 0.03), T3 tumors (OR 14.3, P = 0.04), lymph node metastasis (OR 5.82, P = 0.03), and D2 lymphadenectomy (OR 4.12, P = 0.007), and, inversely, postoperative complications (OR 0.25, P = 0.008). Median overall survival (OS) was 25.1 months and 5-year OS was 36.5%. Predictors of OS were preexisting cardiac disease (hazard ratio (HR) 2.7, 95% CI 1.13–6.46), concurrent splenectomy (HR 4.11, 95% CI 1.68–10.0), tumor stage (reference stage I; stage II HR 2.62; 95% CI 0.99–6.94; stage III HR 4.86, 95% CI 1.81–13.02), and D2 lymphadenectomy (HR 0.43, 95% CI 0.19–0.95). After accounting for these factors, adjuvant chemotherapy administration was associated with improved OS (HR 0.33, 95% CI 0.14–0.82). Conclusion: Completion of perioperative chemotherapy was successful in two thirds of patients with gastric cancer and was independently associated with improved survival.

Original languageEnglish
Pages (from-to)1984-1992
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number12
DOIs
StatePublished - Dec 1 2017

Keywords

  • Chemotherapy
  • Completion
  • Gastric cancer
  • Perioperative
  • Risk factors

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