Implications of lymph node staging on selection of adjuvant therapy for gastric cancer in the United States: A propensity score-ma tched analysis

Jashodeep Datta, Matthew T. McMillan, Brett L. Ecker, Giorgos C. Karakousis, Ronac Mamtani, John P. Plastaras, Bruce J. Giantonio, Jeffrey A. Drebin, Daniel T. Dempsey, Douglas L. Fraker, Robert E. Roses

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objective: To compare the efficacy of adjuvant chemoradiotherapy (CRT) and chemotherapy alone (CA) in gastric adenocarcinoma patients undergoing gastrectomy in the United States (US). Background: A majority of US gastric adenocarcinoma patients are inadequately staged (<15 nodes examined). Despite this, and limited data comparing adjuvant CRT with CA in US patients, national guidelines endorse CA in selected patients undergoing D2 lymphadenectomy. Methods: Resected stage IB-III gastric adenocarcinoma patients receiving adjuvant CRT or CA (n = 3008) were identified in the National Cancer Database (1998-2006). Cox regression identified covariates associated with overall survival (OS). CRT and CA cohorts were matched (3:1) by propensity scores based on the likelihood of receiving CA. OS was compared by KaplanMeier estimates. Results: Adjuvant CA was associated with an increased risk of death (HR 1.29, P < 0.001) relative to CRT. Inadequate lymph node staging (LNS) and nodal positivity were strong predictors of risk-adjusted mortality (P < 0.001). After propensity score-matching, CRT demonstrated superior median OS compared with CA (36.1 vs 28.9 m; P < 0.0001), regardless of stage. CRT was superior to CA in inadequately staged patients (33.1 m vs 24.5 m; P < 0.001); this benefit was less pronounced with increasing nodal examination. CRT improved OS in nodepositivedisease(29.8 vs22.2m; P < 0.001),regardlessofLNSadequacy. Innodenegative disease, OS did not differ significantly between CRT and CA cohorts; however,node-negativepatientsundergoinginadequateLNSbenefitedfromCRT. Conclusions: CRT is associated with improved stage-stratified OS compared with CA. Lymph node status and adequacy of surgical staging should influence adjuvant therapy selection in the United States.

Original languageEnglish (US)
Pages (from-to)298-305
Number of pages8
JournalAnnals of surgery
Issue number2
StatePublished - 2016
Externally publishedYes


  • Adjuvant therapy
  • Chemotherapy
  • Gastric cancer
  • Lymph node staging
  • Node positivity

ASJC Scopus subject areas

  • Surgery


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