Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer

12 May 2022
Mariana Serrano, Jhajaira M Araujo, Cristian Pacheco, Jackeline Macetas, Mariella A Blum, Alfredo Carrato, Eloy Ruiz, Francisco Berrospi, Carlos Luque, Ivan Chavez, Eduardo Payet, Luis Taxa, Paola Montenegro

Background: Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru; however, there are no prospective trials for adjuvant chemotherapy in GC after curative gastrectomy in this country. The objective of this study was to evaluate the effectiveness of adjuvant chemotherapy in stage II–III gastric cancer patients who underwent D2 gastrectomy.

Methods: We included patients with stage II–III gastric cancer who underwent radical gastrectomy and D2 dissection between 2014 and 2016 at our institution. Patients received 3-week cycles of capecitabine (1,000 mg/m2 twice daily on days 1–14) plus oxaliplatin (130 mg/m2 on day 1) for 6 months. Survival curves were estimated with the Kaplan–Meier method, and the Cox proportional hazards model was used to identify prognostic factors for survival.

Results: In total, 173 patients were included: 100 (57.8%) patients received adjuvant chemotherapy and surgery (AChS) and 73 (42.2%) surgery alone (SA). Three-year disease-free survival (DFS) was higher in the AChS groups (69%) than in the SA group (52.6%) (p = 0.034). Regarding overall survival (OS), 31 patients (31%) died in the AChS group compared with 34 (46.6%) in the SA group (p = 0.027). In the multivariate analysis, adjuvant chemotherapy was an independent prognostic factor for DFS (HR = 0.60; 95% CI = 0.37–0.97; p = 0.036) and OS (HR = 0.58; 95% CI = 0.36–0.95; p = 0.029). ACh showed consistent benefit in DFS and OS for patients with albumin >3.5 g/dL, lymphovascular and perineural invasion, pT4, pN2–3, pathologic stage (PS) IIIA and IIIB and lymph node ratio (LNR) > 13.1.

Conclusion: These data suggest that adjuvant capecitabine and oxaliplatin reduce the recurrence and mortality in patients with stage II–III gastric cancer who underwent D2 gastrectomy. PS IIIA and IIIB and LNR > 13.1 benefited more from receiving adjuvant chemotherapy and poorly cohesive gastric carcinoma did not significantly reduce the rates of survival.

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