Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer

A multi-institutional analysis

Aslam Ejaz, Gaya Spolverato, Yuhree Kim, Malcolm H. Squires, George Poultsides, Ryan Fields, Mark Bloomston, Sharon M. Weber, Konstantinos Votanopoulos, David J. Worhunsky, Douglas Swords, Linda X. Jin, Carl Schmidt, Alexandra W. Acher, Neil Saunders, Clifford S. Cho, Joseph M. Herman, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background. Use of perioperative chemotherapy (CTx) alone versus chemoradiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the utilization and effect of CTx alone versus cXRT on patients having undergone curative-intent resection for gastric cancer.Methods. Using the multi-institutional US Gastric Cancer Collaborative database, we identified 505 gastric cancer patients between 2000 and 2012 who received perioperative therapy in addition to curative-intent resection. The impact of perioperative therapy on survival was analyzed by the use of propensity-score matching of clinicopathologic factors among patients who received CTx alone versus cXRT.Results. Median patient age was 62 years, and most patients were male (58.2%). Most patients had a T3 (38.7%) or T4 (36.8%) lesion and lymph node metastasis (73.4%). A total of 211 (42.8%) patients received perioperative CTx alone, whereas the remaining 294 (58.2%) patients received cXRT. Factors associated with receipt of cXRT were younger age (odds ratio, 1.93) and lymph node metastasis (odds ratio, 4.02; both P <0.05). At a median follow-up of 28 months, the median overall survival (OS) was 33.4 months, and the 5-year OS was 36.7%. Factors associated with worse overall survival included large tumor size [hazard ratio (HR), 1.83], T3 (HR 2.96) or T4 (HR 4.02) tumors, and lymph node metastasis (HR 1.57; all P <0.05). In contrast, receipt of cXRT was associated with improved long-term OS (CTx alone, 20.9 months; cXRT, 46.7 months; HR 0.51; P <0.001). Conclusions. cXRT was utilized in 58% of patients undergoing curative-intent resection for gastric cancer. With propensity score-matched analysis, cXRT was an independent factor associated with improved recurrence-free survival and OS.

Original languageEnglish (US)
Pages (from-to)3412-3421
Number of pages10
JournalAnnals of Surgical Oncology
Volume21
Issue number11
DOIs
StatePublished - 2014

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Stomach Neoplasms
Radiotherapy
Survival
Propensity Score
Lymph Nodes
Neoplasm Metastasis
Odds Ratio
Therapeutics
Neoplasms
Databases
Recurrence
Drug Therapy

ASJC Scopus subject areas

  • Surgery
  • Oncology
  • Medicine(all)

Cite this

Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer : A multi-institutional analysis. / Ejaz, Aslam; Spolverato, Gaya; Kim, Yuhree; Squires, Malcolm H.; Poultsides, George; Fields, Ryan; Bloomston, Mark; Weber, Sharon M.; Votanopoulos, Konstantinos; Worhunsky, David J.; Swords, Douglas; Jin, Linda X.; Schmidt, Carl; Acher, Alexandra W.; Saunders, Neil; Cho, Clifford S.; Herman, Joseph M.; Maithel, Shishir K.; Pawlik, Timothy M.

In: Annals of Surgical Oncology, Vol. 21, No. 11, 2014, p. 3412-3421.

Research output: Contribution to journalArticle

Ejaz, A, Spolverato, G, Kim, Y, Squires, MH, Poultsides, G, Fields, R, Bloomston, M, Weber, SM, Votanopoulos, K, Worhunsky, DJ, Swords, D, Jin, LX, Schmidt, C, Acher, AW, Saunders, N, Cho, CS, Herman, JM, Maithel, SK & Pawlik, TM 2014, 'Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer: A multi-institutional analysis', Annals of Surgical Oncology, vol. 21, no. 11, pp. 3412-3421. https://doi.org/10.1245/s10434-014-3776-5
Ejaz, Aslam ; Spolverato, Gaya ; Kim, Yuhree ; Squires, Malcolm H. ; Poultsides, George ; Fields, Ryan ; Bloomston, Mark ; Weber, Sharon M. ; Votanopoulos, Konstantinos ; Worhunsky, David J. ; Swords, Douglas ; Jin, Linda X. ; Schmidt, Carl ; Acher, Alexandra W. ; Saunders, Neil ; Cho, Clifford S. ; Herman, Joseph M. ; Maithel, Shishir K. ; Pawlik, Timothy M. / Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer : A multi-institutional analysis. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 11. pp. 3412-3421.
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abstract = "Background. Use of perioperative chemotherapy (CTx) alone versus chemoradiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the utilization and effect of CTx alone versus cXRT on patients having undergone curative-intent resection for gastric cancer.Methods. Using the multi-institutional US Gastric Cancer Collaborative database, we identified 505 gastric cancer patients between 2000 and 2012 who received perioperative therapy in addition to curative-intent resection. The impact of perioperative therapy on survival was analyzed by the use of propensity-score matching of clinicopathologic factors among patients who received CTx alone versus cXRT.Results. Median patient age was 62 years, and most patients were male (58.2{\%}). Most patients had a T3 (38.7{\%}) or T4 (36.8{\%}) lesion and lymph node metastasis (73.4{\%}). A total of 211 (42.8{\%}) patients received perioperative CTx alone, whereas the remaining 294 (58.2{\%}) patients received cXRT. Factors associated with receipt of cXRT were younger age (odds ratio, 1.93) and lymph node metastasis (odds ratio, 4.02; both P <0.05). At a median follow-up of 28 months, the median overall survival (OS) was 33.4 months, and the 5-year OS was 36.7{\%}. Factors associated with worse overall survival included large tumor size [hazard ratio (HR), 1.83], T3 (HR 2.96) or T4 (HR 4.02) tumors, and lymph node metastasis (HR 1.57; all P <0.05). In contrast, receipt of cXRT was associated with improved long-term OS (CTx alone, 20.9 months; cXRT, 46.7 months; HR 0.51; P <0.001). Conclusions. cXRT was utilized in 58{\%} of patients undergoing curative-intent resection for gastric cancer. With propensity score-matched analysis, cXRT was an independent factor associated with improved recurrence-free survival and OS.",
author = "Aslam Ejaz and Gaya Spolverato and Yuhree Kim and Squires, {Malcolm H.} and George Poultsides and Ryan Fields and Mark Bloomston and Weber, {Sharon M.} and Konstantinos Votanopoulos and Worhunsky, {David J.} and Douglas Swords and Jin, {Linda X.} and Carl Schmidt and Acher, {Alexandra W.} and Neil Saunders and Cho, {Clifford S.} and Herman, {Joseph M.} and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
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TY - JOUR

T1 - Impact of external-beam radiation therapy on outcomes among patients with resected gastric cancer

T2 - A multi-institutional analysis

AU - Ejaz, Aslam

AU - Spolverato, Gaya

AU - Kim, Yuhree

AU - Squires, Malcolm H.

AU - Poultsides, George

AU - Fields, Ryan

AU - Bloomston, Mark

AU - Weber, Sharon M.

AU - Votanopoulos, Konstantinos

AU - Worhunsky, David J.

AU - Swords, Douglas

AU - Jin, Linda X.

AU - Schmidt, Carl

AU - Acher, Alexandra W.

AU - Saunders, Neil

AU - Cho, Clifford S.

AU - Herman, Joseph M.

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2014

Y1 - 2014

N2 - Background. Use of perioperative chemotherapy (CTx) alone versus chemoradiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the utilization and effect of CTx alone versus cXRT on patients having undergone curative-intent resection for gastric cancer.Methods. Using the multi-institutional US Gastric Cancer Collaborative database, we identified 505 gastric cancer patients between 2000 and 2012 who received perioperative therapy in addition to curative-intent resection. The impact of perioperative therapy on survival was analyzed by the use of propensity-score matching of clinicopathologic factors among patients who received CTx alone versus cXRT.Results. Median patient age was 62 years, and most patients were male (58.2%). Most patients had a T3 (38.7%) or T4 (36.8%) lesion and lymph node metastasis (73.4%). A total of 211 (42.8%) patients received perioperative CTx alone, whereas the remaining 294 (58.2%) patients received cXRT. Factors associated with receipt of cXRT were younger age (odds ratio, 1.93) and lymph node metastasis (odds ratio, 4.02; both P <0.05). At a median follow-up of 28 months, the median overall survival (OS) was 33.4 months, and the 5-year OS was 36.7%. Factors associated with worse overall survival included large tumor size [hazard ratio (HR), 1.83], T3 (HR 2.96) or T4 (HR 4.02) tumors, and lymph node metastasis (HR 1.57; all P <0.05). In contrast, receipt of cXRT was associated with improved long-term OS (CTx alone, 20.9 months; cXRT, 46.7 months; HR 0.51; P <0.001). Conclusions. cXRT was utilized in 58% of patients undergoing curative-intent resection for gastric cancer. With propensity score-matched analysis, cXRT was an independent factor associated with improved recurrence-free survival and OS.

AB - Background. Use of perioperative chemotherapy (CTx) alone versus chemoradiation therapy (cXRT) in the treatment of resectable gastric cancer remains varied. We sought to define the utilization and effect of CTx alone versus cXRT on patients having undergone curative-intent resection for gastric cancer.Methods. Using the multi-institutional US Gastric Cancer Collaborative database, we identified 505 gastric cancer patients between 2000 and 2012 who received perioperative therapy in addition to curative-intent resection. The impact of perioperative therapy on survival was analyzed by the use of propensity-score matching of clinicopathologic factors among patients who received CTx alone versus cXRT.Results. Median patient age was 62 years, and most patients were male (58.2%). Most patients had a T3 (38.7%) or T4 (36.8%) lesion and lymph node metastasis (73.4%). A total of 211 (42.8%) patients received perioperative CTx alone, whereas the remaining 294 (58.2%) patients received cXRT. Factors associated with receipt of cXRT were younger age (odds ratio, 1.93) and lymph node metastasis (odds ratio, 4.02; both P <0.05). At a median follow-up of 28 months, the median overall survival (OS) was 33.4 months, and the 5-year OS was 36.7%. Factors associated with worse overall survival included large tumor size [hazard ratio (HR), 1.83], T3 (HR 2.96) or T4 (HR 4.02) tumors, and lymph node metastasis (HR 1.57; all P <0.05). In contrast, receipt of cXRT was associated with improved long-term OS (CTx alone, 20.9 months; cXRT, 46.7 months; HR 0.51; P <0.001). Conclusions. cXRT was utilized in 58% of patients undergoing curative-intent resection for gastric cancer. With propensity score-matched analysis, cXRT was an independent factor associated with improved recurrence-free survival and OS.

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