Survival Analysis Of Adjuvant Chemoradiotherapy In Locally Advanced Gastric Cancer Patients After D2 Resection

Objective: To compare the effect of adjuvant chemoradiotherapy(CRT)and chemotherapy(Ch T)alone on survival of patients with locally advanced gastric cancer after D2 resection,and explore the clinical value of adjuvant chemoradiotherapy.Methods: A total of 192 patients with locally advanced stage(T3-4N + M0)who underwent D2 resection at the Affiliated Hospital of Qingdao University from June 2010 to June 2014 were were enrolled into the research subjects.?2test was used to compare the baseline characteristics of patients from two group.The Log-rank test was used to compare the total recurrence and survival of the two groups,and results were plotted into a survival curve using the Kaplan-Meier method.Prognostic factors affecting relapse and survival were established through univariate and multivariate analysis.Finally,the effect of adjuvant CRT and Ch T on the recurrence and survival of patients in different subgroups was further evaluated by subgroup analysis.Results: At the date of evaluation,the median follow-up time was 54 months for the entire group.A total of 126 patients experienced deaths(63 deaths in both groups),and 127 recurrences occurred(63 patients in the CRT arm and 64 patients in the Ch T arm).The estimated DFS probability for 3-and 5-year in the CRT and Ch T arms was 52.9% vs 36.7%(P=0.024)and 41.2% vs 31.1%(P=0.148),respectively.The estimated OS probability was 82.4% vs 70.0%(P=0.044)and 52.0% vs 35.6%(P=0.022)in the same consecutive order.The locoregional recurrence rate in the CRT group was significantly lower than that in the Ch T group(P = 0.031).There was no statistical difference in the rates of peritoneal or distant metastasis between the two groups.Through univariate and multivariate analysis,adjuvant CRT,lymph node staging,and tumor diameter were considered to be independent factors affecting recurrence and survival.Patients with a tumor diameter of ?6 cm,lymph node stage of N1-2,and those receiving adjuvant CRT had a lower risk of recurrence,longer disease-free survival and overall survival.Subgroup analysis found that patients with lymph node stage N1-2,tumor diameter> 6cm,and poorly differentiated cancers could obtain significant disease-free survival or overall survival from adjuvant CRT(all P values were less than 0.05).Conclusion: Patients with locally advanced gastric cancer undergoing D2 radical resection have a high risk of recurrence and poor prognosis.Compared with chemotherapy alone,patients receiving adjuvant chemoradiotherapy had a superior rate of disease-free survival and overall survival.Chemotherapy can significantly reduce the risk of locoregional relapse in patients.Through univariate and multivariate analysis,adjuvant CRT,lymph node staging,and tumor diameter were considered to be independent factors affecting recurrence and survival.Subgroup analysis found that patients with lymph node stage N1-2,tumor diameter> 6cm,and poorly differentiated cancers could obtain significant disease-free survival or overall survival from adjuvant CRT.