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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Correlation between postoperative chemotherapy regimen and survival in patients with resectable gastric adenocarcinoma accompanied with vascular cancer thrombus
Ze-Feng Yang, Zhuan-Xia Dong, Chen-Jie Dai, Li-Zheng Fu, Hong-Mei Yu, Yu-Sheng Wang
Ze-Feng Yang, Chen-Jie Dai, Li-Zheng Fu, Hong-Mei Yu, Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Zhuan-Xia Dong, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Hong-Mei Yu, Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan 030001, Shanxi Province, China
Hong-Mei Yu, MOE Key Laboratory of Coal Environmental Pathogenicity and Prevention, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Yu-Sheng Wang, Department of Oncology Digestive, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Yu-Sheng Wang, Department of Digestive Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: Wang YS, Yu HM and Yang ZF designed the research study; Yang ZF prepared the materials; Yang ZF, Dong ZX, Dai CJ, Fu LZ collected the data; Wang YS, Yu HM and Yang ZF analyzed the data; Yang ZF wrote the manuscript and edited it; Wang YS contributed to the writing review; Wang YS and Yang ZF completed the writing–final draft; Wang YS contributed fund support.
Supported by Shanxi Provincial Health Commission, No. 20222025; and Four “Batches” Innovation Project of Invigorating Medical Cause through Science and Technology of Shanxi Province, No. 2023XM024.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of Shanxi Cancer Hospital (Ethical number: KY2023010).
Informed consent statement: All patients provided written pan-informed consent for the collection and release of their medical information during their first visit to the hospital.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data will be shared on reasonable request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yu-Sheng Wang, Doctor, MD, Chief Doctor, Deputy Director, Professor, Vice General Manager, Department of Oncology Digestive, The First Hospital of Shanxi Medical University, No. 85 South Jiefang Road, Taiyuan 030001, Shanxi Province, China. wangyusheng@sxmu.edu.cn
Received: January 18, 2024
Revised: April 11, 2024
Accepted: April 23, 2024
Published online: June 27, 2024
Processing time: 163 Days and 18.9 Hours
BACKGROUND
Patients with resectable gastric adenocarcinoma accompanied by vascular cancer thrombus (RGAVCT) have a poor prognosis, with a 5-year survival rate ranging from 18.42%-53.57%. These patients need a reasonable postoperative treatment plan to improve their prognosis.
AIM
To determine the most effective postoperative chemotherapy regimen for patients with RGAVCT.
METHODS
We retrospectively collected the clinicopathological data of 530 patients who underwent radical resection for gastric cancer between January 2017 and January 2022 and who were pathologically diagnosed with gastric adenocarcinoma with a choroidal cancer embolus. Furthermore, we identified the high-risk variables that can influence the prognosis of patients with RGAVCT by assessing the clinical and pathological features of the patients who met the inclusion criteria. We also assessed the significance of survival outcomes using Mantel-Cox univariate and multivariate analyses. The subgroups of patients with stages I, II, and III disease who received single-, dual-, or triple-drug regimens following surgery were analyzed using SPSS 25.0 and the ggplot2 package in R 4.3.0.
RESULTS
In all, 530 eligible individuals with RGAVCT were enrolled in this study. The median overall survival (OS) of patients with RGAVCT was 24 months, and the survival rates were 80.2%, 62.5%, and 42.3% at 12, 24, and 59 months, respectively. Preoperative complications, tumor size, T stage, and postoperative chemotherapy were identified as independent factors that influenced OS in patients with RGAVCT according to the Cox multivariate analysis model. A Kaplan-Meier analysis revealed that chemotherapy had no effect on OS of patients with stage I or II RGAVCT; however, chemotherapy did have an effect on OS of stage III patients. Stage III patients who were treated with chemotherapy consisting of dual- or triple-agent regimens had better survival than those treated with single-agent regimens, and no significant difference was observed in the survival of patients treated with chemotherapy consisting of dual- or triple-agent regimens.
CONCLUSION
For patients with stage III RGAVCT, a dual-agent regimen of postoperative chemotherapy should be recommended rather than a triple-agent treatment, as the latter is associated with increased frequency of adverse events.
Core Tip: In patients with resectable gastric adenocarcinoma accompanied by vascular cancer thrombus (RGAVCT), postoperative chemotherapy has an independent effect on overall survival and may even improve survival. Patients with stage I and II RGAVCT should not receive postoperative chemotherapy, and low-toxicity single-agent therapy is advised even in the presence of high-risk variables. For patients with stage III RGAVCT, a dual-agent regimen of postoperative chemotherapy should be recommended rather than a triple-agent treatment, as the latter is associated with increased risks.
