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Quality Improvement/Clinical Outcomes

E376: Adjuvant Therapy After Upfront Resection of T2N0 Gastric Cancer: Is It Necessary?

Introduction: Upfront resected stage T2N0 gastric cancer (pT2N0) presents a particular challenge as National Comprehensive Cancer Network (NCCN) recommendations allow for surgery alone or postoperative adjuvant therapy (chemotherapy or chemoradiation, AT). The inclusion of AT is not without potential morbidity and may represent overtreatment in subsets of patients. Herein, we aimed to understand outcomes for upfront resected pT2N0 with or without postoperative therapy.

Methods: The National Cancer Database (NCDB) was queried for adult patients diagnosed with gastric adenocarcinoma (2004-2019).  Patients with pT2N0 who underwent upfront surgical resection were included in the study. Patients were excluded if they had esophageal involvement, evidence of metastatic disease, or received treatment at > 1 Commission of Cancer accredited institution. Demographics, treatment-variables, and oncologic outcomes were compared between surgery alone or with postoperative AT. Multivariable regression and Cox proportional hazards analysis identified factors predictive AT receipt. A log-rank test and Cox proportional hazards model with 3-month landmark analysis assessed overall survival.

Results: Of the 920 patients that were included in this study, 771 (83.8%) underwent surgery alone while 149 (16.2%) received AT. Patients receiving surgery alone were older (72 years vs 61.8 years, p< 0.001), white (86.7% vs 76.7% minority, p =0.001), hailed from areas with less education (< 7% 86.5% vs >7% 82.1% p=0.03), and traveled farther for care (29.1 miles vs 23.9 miles, p = 0.02) compared to patients who received postoperative AT. Sex, comorbidity scores, staging, and tumor characteristics (size or histology) were comparable between groups. Patients who received AT after resection demonstrated longer overall survival (p=0.002, Figure) compared to surgery alone group. On multivariate analysis, age (OR 0.94 95%CI 0.91-0.95), race (black OR 1.75 95%CI 1.02-2.98, other OR 1.98 95%CI 1.12-3.51; ref white) and hispanic ethnicity (OR 2.44 95% CI 0.34-2.28) were associated with AT receipt. Hispanic ethnicity (HR 0.55 95%CI 0.37-0.87) and higher comorbidity score (score 2 HR 1.89 95%CI 1.34-2.68, score≧3 HR 1.90 95%CI 1.21-2.98; ref score 0) were associated with improved survival. However, AT was not independently associated with OS (HR 1.74, 95%CI 0.61-1.90).

Conclusions: For pT2N0 gastric cancer, we observed a potential signal for improved survival with AT. Additional research is required to understand the particular subsets of disease which may garner a true benefit.

Learning Objectives:

  • Upon completion, participant will be able to understand the treatment options available for patients with pT2N0 gastric cancer.
  • Upon completion, participant will be able to clarify which treatment paradigms are most efficacious for this subset of GC patients.
  • Upon completion, participant will be able to understand what factors may predict receipt of adjuvant therapy in this subset of GC patients.