A study on candidates benefiting from adjuvant chemotherapy in patients with pT1N1M0 gastric cancer

Sen LI; Pengfei MA; Junli ZHANG; Yanghui CAO; Chenyu LIU; Xijie ZHANG; Yingwei XUE; Yuzhou ZHAO

ABSTRACT

Objective:

To investigate whether adjuvant chemotherapy could be beneficial for patients with pT1N1M0 (stage ⅠB) gastric cancer.

Methods:

From Jan 2010 to Dec 2016, 185 patients with pT1N1M0 gastric cancer who were surgically resected at Henan Cancer Hospital were retrospectively analyzed. The patients were divided into chemotherapy group ( n=100) and non chemotherapy group ( n=85).

Results:

For disease-free survival (DFS) analysis, univariate survival analysis showed that age, examined lymph nodes, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DFS (all P<0.05); multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.363, 95% CI 0.160-0.827, P=0.016), vascular invasion ( HR=4.117, 95% CI 1.796-9.436, P=0.001) and postoperative chemotherapy ( HR=4.530, 95% CI 1.932-10.622, P=0.001) were independent risk factors for DFS. For disease-specific survival (DSS) analysis, univariate survival analysis showed that lymph node resection, vascular invasion, nerve invasion and adjuvant chemotherapy were associated with DSS; multivariate analysis showed that lymph node resection ≥ 16 ( HR=0.344, 95% CI 0.144-0.822, P=0.016), vascular invasion ( HR=5.113, 95% CI 2.029-12.887, P=0.001) and postoperative chemotherapy ( HR=4.694, 95% CI 1.854-11.888, P=0.001)were independent risk factors for DSS. According to examined lymph nodes and vascular invasion , pT1N1M0 patients were divided into three risk categories (high, medium and low). DFS and DSS were significantly different among the three risk groups (all P<0.001, respectively).

Conclusion:

pT1N1M0 gastric cancer patients are expected to benefit from adjuvant chemotherapy. Patients with less than 16 lymph nodes and vascular invasion may be particularly suitable for adjuvant chemotherapy.