Analysis of patterns of recurrence and prognostic factors in 171 locally advanced gastric cancer patients with radiotherapy and concurrent chemotherapy after radical gastrectomy
Ma Yifu1, Yang Yongqiang1, Xing Pengfei1, Wu Yongyou2, Zhang Liyuan1
1Department of Radiotherapy&Oncology, Institute of Radiotherapy&Oncology Soochow University/Suzhou Key Laboratory for Combined Radiotherapy and Immunotherapy of Cancer/Department of Radiotherapy&Oncology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China; 2Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215004, China
Abstract：Objective To retrospectively analyze prognostic factors and patterns of recurrence in locally advanced gastric cancer patients receiving chemoradiotherapy (CRT) after radical gastrectomy, aiming to provide reference for postoperative CRT of locally advanced gastric cancer. Methods Clinical data of 171 patients with curatively resected gastric carcinoma who received postoperative CRT in our hospital between 2008 and 2020 were retrospectively analyzed. The disease-free survival and overall survival (OS) rates were calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox model. Results The median follow-up duration was 63 months. The follow-up rate was 93.6%. 31.0% and 66.7% of the enrolled patients were classified in pathological stage Ⅱ and Ⅲ. The acute grade 3 or 4 gastrointestinal and hematological toxicity rates were 8.8% and 9.9%, respectively. In total, 166 patients completed the entire CRT regimen. No toxicity-related death occurred. Regarding patterns of recurrence, 17 patients had locoregional recurrence, 29had distant metastasis and 12had peritoneal metastasis. The 1-, 3-and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, while the 1-, 3-and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. In the multivariate analysis, pathological T stage, perineural invasion and lymph node ratio (LNR) were found to be the independent predictors of OS. Conclusions Postoperative intensity-modulated radiation therapy and chemotherapy are well tolerated, with acceptable toxicities and encouraging locoregional tumor control and long-term survival. LNR can be used as an independent prognostic indicator for OS. Adjuvant CRT should be considered for all patients with a high risk of locoregional recurrence.
Ma Yifu,Yang Yongqiang,Xing Pengfei et al. Analysis of patterns of recurrence and prognostic factors in 171 locally advanced gastric cancer patients with radiotherapy and concurrent chemotherapy after radical gastrectomy[J]. Chinese Journal of Radiation Oncology, 2022, 31(5): 438-444.
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