Back to Annual Meeting Posters

Objective:To examine the influence of therapeutic approach on outcomes in patients with resectable, locally advanced gastric cancer.
Design:Retrospective cohort study.
Setting:Tertiary-care cancer center.
Patients:All patients with stages Ib-IIIc adenocarcinoma of the stomach or gastroesophageal junction (GEJ) undergoing potentially curative resection from 2000 - 2011.
Interventions:None.
Main Outcome Measures:Rates of overall and disease-specific survival, pathologic tumor response, and R0 resection rates.
Results:A total of 191 patients were identified, including 80 (42%) patients who received preoperative chemotherapy (n = 40) or chemoradiation (n =40) followed by surgery, and 111 (58%) patients who underwent surgery first, including 40 patients who underwent surgery followed by chemoradiation, and 71 patients who underwent surgery alone. Of the 80 patients who received preoperative therapy, 44 also received additional post-operative chemotherapy. Adjuvant therapy was recommended to a large proportion of the 71 patients who did not receive it, but many either refused or were too ill to proceed. Tumor stage distribution was well-matched among the groups. Resected tumors in the preoperative therapy group were of similar size as those in the surgery-first group, though 6 (7.5%) tumors demonstrated complete pathologic response. The R0 resection rates were 91% for the preoperative therapy group and 89% for the surgery upfront group. With a median follow-up of 19 months, patients receiving preoperative therapy had higher overall and disease-specific survival rates (66% and 88%, respectively) than those proceeding straight to surgery (49% and 68%, respectively) (p = 0.016 and 0.004).
Conclusions:Patients with resectable, locally advanced adenocarcinoma of the stomach and GEJ should be offered preoperative chemotherapy or chemoradiation therapy, as such therapy engenders improved survival rates compared to a surgery-first approach.