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Authors Zhou ML, Yang W, Wang YQ, Mo M, Hu R, Wang Y, Yang JN, Li GC, Wang YN, Zhang Z
Received 19 November 2018
Accepted for publication 12 March 2019
Published 28 May 2019 Volume 2019:11 Pages 4855—4870
DOI https://doi.org/10.2147/CMAR.S195130
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Dr Beicheng Sun
Purpose: N3
gastric cancer (GC) is characterized by a heavy burden of lymph node metastasis
and a high postoperative recurrence rate. The role of radiotherapy in this
group of patients remains undetermined. The purpose of this study was to
compare the effectiveness of adjuvant chemoradiotherapy (CRT) and adjuvant
chemotherapy (ChT) for N3 GC after D2/R0 resection.
Patients and methods: From January
2004 to December 2015, patients with N3 GC in the database of Fudan University
Shanghai Cancer Center were retrospectively reviewed. The eligible patients
were enrolled in an adjuvant CRT group and an adjuvant ChT group. Four
different methods based on a propensity score model were used to balance the
baseline characteristics. Then, survival analyses between the two groups were
performed in addition to patterns of recurrence and subgroup analyses.
Results: In total,
175 and 365 eligible patients were enrolled into the CRT and ChT groups,
respectively. After balancing, the disease-free survival (DFS) of patients in
the CRT group was significantly better than that of patients in the ChT group (p =0.021). Subgroup
analyses showed that patients with N3a GC benefitted from adjuvant CRT.
Conclusion: Compared
with adjuvant ChT, adjuvant CRT can further improve the DFS of patients with N3
GC after D2/R0 resection. Patients with lymph node metastases should be further
stratified when selecting patients for adjuvant CRT.
Keywords: stomach
neoplasms, gastrectomy, chemoradiation, propensity score, survival analysis