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Indications for Adjuvant Chemotherapy in Stage II Gastric Cancer After D2 Gastrectomy–A Chinese Multicenter Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The benefit of adjuvant chemotherapy (AC) for patients with stage II gastric cancer remains controversial. This study aimed to explore the indications for adjuvant chemotherapy in patients with stage II gastric cancer by constructing an individual prediction model.

Patients and Methods

In this Chinese multicenter study, a total of 1012 patients with stage II gastric cancer after D2 radical gastrectomy were retrospectively analyzed. All patients were randomly assigned to a training cohort (n = 674) or a validation cohort (n = 338). A nomogram was constructed according to the training cohort. Concordance index (C-index), the area under the receiver operating characteristic (ROC) curves (AUC), calibration curves, and decision curve analysis (DCA) were applied to evaluate the performance of the nomogram. ROC curves and stratified survival were used to determine the patients’ cutoff score for a benefit from adjuvant chemotherapy. An additional 338 patients were used as a validation cohort to validate the feasibility of using this nomogram to guide individualized therapy for patients with stage II gastric cancer.

Results

Univariate and multivariate analyses illustrated that age, sex, tumor location, size, carcinoembryonic antigen (CEA), hemoglobin (HB), and T stage were independent prognostic factors for overall survival (OS), and they were used to establish a nomogram. The cutoff value was determined by ROC curve analysis, and patients were divided into a high-risk group (< 239 points) and a low-risk group (≥ 239 points). There was no significant difference in the OS of low-risk patients in either the training cohort or the validation cohort. However, the OS of high-risk patients in the AC group was better than that of patients in the surgery-only group.

Conclusions

This prediction model can be applied to guide treatment of patients with stage II gastric cancer. High-risk patients (< 239 points) are likely to benefit from AC after D2 radical gastrectomy.

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Acknowledgement

This study is supported by Guangzhou Science and Technology Project (Grant Number 201803010040), Fund of the Sixth Affiliated Hospital of Sun Yat-sen University (Grant Number P20200217202309876), and National Key Clinical Discipline.

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Author notes

  1. Zi-Jian Deng, Jun Lu, and Run-Cong Nie contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Zi-Jian Deng MD, Jia-Ming Fang MD, **-Jie Chen MD, Jun-Jie Liu MD, **an-Zhe Li MD, Lei Lian MD, PhD, Jun-Sheng Peng MD & Shi Chen MD, PhD

  2. Guangdong Institute of Gastroenterology, Guangzhou, People’s Republic of China

    Zi-Jian Deng MD, Jia-Ming Fang MD, **-Jie Chen MD, Jun-Jie Liu MD, **an-Zhe Li MD, Lei Lian MD, PhD, Jun-Sheng Peng MD & Shi Chen MD, PhD

  3. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Zi-Jian Deng MD, Jia-Ming Fang MD, **-Jie Chen MD, Jun-Jie Liu MD, **an-Zhe Li MD, Lei Lian MD, PhD, Jun-Sheng Peng MD & Shi Chen MD, PhD

  4. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China

    Jun Lu MD & Chang-Ming Huang MD

  5. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China

    Run-Cong Nie MD, PhD & Ying-Bo Chen MD

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  1. Zi-Jian Deng MD
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Correspondence to Lei Lian MD, PhD, Jun-Sheng Peng MD or Shi Chen MD, PhD.

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Deng, ZJ., Lu, J., Nie, RC. et al. Indications for Adjuvant Chemotherapy in Stage II Gastric Cancer After D2 Gastrectomy–A Chinese Multicenter Study. Ann Surg Oncol 29, 8214–8224 (2022). https://doi.org/10.1245/s10434-022-12108-9

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