Benefit of Adjuvant Chemoradiotherapy for Gastric Adenocarcinoma: A SEER Population Analysis.

Steven Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee
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Abstract

Background: Despite results of the Intergroup 0116 (INT-0116) study showing an overall survival benefit of adjuvant chemoradiotherapy in gastric adenocarcinoma, its use in the United States remains controversial. The Surveillance Epidemiology of End Results (SEER) database was used to compare cause-specific survival outcomes in resected gastric adenocarcinoma with various adjuvant therapies and patterns of care.

Methods: Individual data from 1988 to 2008 were selected for patients with resected, nonmetastatic gastric adenocarcinoma. These patients were stratified by stage (American Joint Committee on Cancer [AJCC], 6th edition), as well as treatment modalities (surgery alone, S; surgery followed by radiotherapy, SR; surgery with chemotherapy, SC; surgery followed by radiotherapy with chemotherapy, SRC; and radiotherapy followed by surgery with chemotherapy, RSC). Overall 21,472 patients (8335 stages IA and 1B; 5944 stage II, 4594 stage III, and 2599 stage IV) were included in this study.

Results: The median age of the cohort was 66 years, with 63.0% male and 66.4% white. The median number of lymph nodes examined was 17.6. Median survival by stage was 96 months for stage I, 30 months for stage II, 20 months for stage III, and 14 months for stage IV. Using the SRC group as the reference group, for stage I patients, S had the most favorable cause-specific survival (hazard ratio [HR], 0.67; confidence interval, [CI] 0.60-0.76). For patients with stage II, III, or IV, those treated with SRC had the best outcome compared with the other treatment modalities. After 1999, the number of patients treated with surgery alone decreased by at least 14%, whereas the number treated with SRC increased by approximately 12%.

Conclusions: This large SEER database analysis showed that stage I patients benefited most from surgery alone, whereas those at more advanced stages benefited most from adjuvant radiotherapy with chemotherapy. This result is consistent with INT-0116 for gastric adenocarcinoma in support of trimodality therapy and is reflected by the increased fraction of patients receiving chemotherapy and adjuvant radiation.

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胃腺癌辅助放化疗的益处:一项SEER人群分析。
背景:尽管Intergroup 0116 (INT-0116)研究结果显示胃腺癌辅助放化疗的总体生存获益,但其在美国的使用仍存在争议。最终结果的监测流行病学(SEER)数据库用于比较各种辅助治疗和护理模式下切除胃腺癌的病因特异性生存结果。方法:选取1988年至2008年切除的非转移性胃腺癌患者的个体数据。这些患者按分期(美国癌症联合委员会[AJCC],第6版)和治疗方式(单独手术,S;手术后放疗,SR;化疗手术,SC;手术后放疗加化疗,SRC;放疗后手术加化疗(RSC)。总计21472例患者(8335例IA期和1B期;5944例II期,4594例III期,2599例IV期)纳入本研究。结果:队列的中位年龄为66岁,男性63.0%,白人66.4%。检查淋巴结的中位数为17.6个。分期的中位生存期为I期96个月,II期30个月,III期20个月,IV期14个月。以SRC组为参照组,对于I期患者,S组具有最有利的病因特异性生存(风险比[HR], 0.67;置信区间,[CI] 0.60-0.76)。对于II期、III期或IV期患者,与其他治疗方式相比,SRC治疗的结果最好。1999年以后,单独接受手术治疗的患者数量减少了至少14%,而接受SRC治疗的患者数量增加了约12%。结论:这项大型SEER数据库分析显示,I期患者从单纯手术中获益最多,而那些更晚期的患者从辅助放疗和化疗中获益最多。这一结果与胃腺癌的INT-0116一致,支持三段式治疗,并反映在接受化疗和辅助放疗的患者比例增加。
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