Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1660-1669
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1660
Tumor recurrence and survival prognosis in patients with advanced gastric cancer after radical resection with radiotherapy and chemotherapy
Shuang-Fa Nie, Chen-Yang Wang, Lei Li, Cheng Yang, Zi-Ming Zhu, Jian-Dong Fei
Shuang-Fa Nie, Chen-Yang Wang, Lei Li, Cheng Yang, Jian-Dong Fei, Department of General Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 75000, Hebei Province, China
Zi-Ming Zhu, Department of Gastrointestinal Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
Author contributions: Nie SF wrote the manuscript; Wang CY, Li L, Yang C and Zhu ZM collected the data; and Fei JD guided the study. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Supported by the Hebei Provincial Department of Finance and the Hebei Provincial Health Commission, No. ZF2023242.
Institutional review board statement: This study has been approved by the Medical Research Ethics Committee of our hospital.
Informed consent statement: Informed consent of patients and their families has been obtained for this study, and informed consent has been signed.
Conflict-of-interest statement: All the authors declare no conflict of interest.
Data sharing statement: Statistical analysis plan, informed consent form, and clinical study report will also be shared if requested. Emails could be sent to the address below to obtain the shared data: 20669645@qq.com.
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: Jian-Dong Fei, Doctor, Department of General Surgery, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Qiaoxi District, Zhangjiakou 75000, Hebei Province, China. 20669645@qq.com
Received: February 7, 2024
Revised: April 24, 2024
Accepted: May 9, 2024
Published online: June 27, 2024
Processing time: 144 Days and 3.9 Hours
Abstract
BACKGROUND

Advanced gastric cancer is a common malignancy that is often diagnosed at an advanced stage and is still at risk of recurrence after radical surgical treatment. Chemoradiotherapy, as one of the important treatment methods for gastric cancer, is of great significance for improving the survival rate of patients. However, the tumor recurrence and survival prognosis of gastric cancer patients after radiotherapy and chemotherapy are still uncertain.

AIM

To analyze the tumor recurrence after radical radiotherapy and chemotherapy for advanced gastric cancer and provide more in-depth guidance for clinicians.

METHODS

A retrospective analysis was performed on 171 patients with gastric cancer who received postoperative adjuvant radiotherapy and chemotherapy in our hospital from 2021 to 2023. The Kaplan-Meier method was used to calculate the recurrence rate and survival rate; the log-rank method was used to analyze the single-factor prognosis; and the Cox model was used to analyze the prognosis associated with multiple factors.

RESULTS

The median follow-up time of the whole group was 63 months, and the follow-up rate was 93.6%. Stage II and III patients accounted for 31.0% and 66.7%, respectively. The incidences of Grade 3 and above acute gastrointestinal reactions and hematological adverse reactions were 8.8% and 9.9%, respectively. A total of 166 patients completed the entire chemoradiotherapy regimen, during which no adverse reaction-related deaths occurred. In terms of the recurrence pattern, 17 patients had local recurrence, 29 patients had distant metastasis, and 12 patients had peritoneal implantation metastasis. The 1-year, 3-year, and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, respectively. The 1-year, 3-year, and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. Multivariate analysis revealed that T stage, peripheral nerve invasion, and the lymph node metastasis rate (LNR) were independent prognostic factors for OS.

CONCLUSION

Postoperative intensity-modulated radiotherapy combined with chemotherapy for gastric cancer treatment is well tolerated and has acceptable adverse effects, which is beneficial for local tumor control and can improve the long-term survival of patients. The LNR was an independent prognostic factor for OS. For patients with a high risk of local recurrence, postoperative adjuvant chemoradiation should be considered.

Keywords: Tumor recurrence, Survival prognosis, Advanced gastric cancer, Radical resection, Retrospective study

Core Tip: This study analyzed the tumor recurrence and survival prognosis of patients with advanced gastric cancer after radical radiotherapy and chemotherapy, and explored the related influencing factors. By collecting clinical data of patients for analysis, we will reveal the actual situation of postoperative recurrence rate and survival rate, and further explore the possible influencing factors, so as to provide scientific basis for clinical practice. The innovation of this study lies in the in-depth analysis of the recurrence pattern and prognostic factors of gastric cancer patients after radical radiotherapy and chemotherapy, which provides a new idea for the formulation of individualized treatment plan, and is expected to provide an important reference for the management and prognosis assessment of patients with advanced gastric cancer.