title: Adjuvant chemotherapy, p53, carcinoembryonic antigen expression and prognosis after D2 gastrectomy for gastric adenocarcinoma.
abstract: OBJECTIVE
  To investigate adjuvant chemotherapy, p53 and carcinoembryonic antigen (CEA) expression and prognosis after D2 gastrectomy for stage II/III gastric adenocarcinoma.
  
  
  METHODS
  A total of 286 patients with stage II or III gastric adenocarcinoma who underwent D2 radical gastrectomy between May 2007 and December 2010 were enrolled into this study. One hundred and sixty-nine of these patients received surgery plus adjuvant chemotherapy, and 117 patients received surgery alone. Tumor expression of p53 and CEA proteins in all patients was evaluated immunohistochemically and correlated with clinicopathological parameters. The Kaplan-Meier curves for overall survival (OS) and disease-free survival (DFS) with log-rank testing were used to compare the survival difference. A Cox proportional hazard regression model was used for multivariate analysis.
  
  
  RESULTS
  Patients with adjuvant chemotherapy had a significantly better median OS (50.87 mo vs 30.73 mo, P = 0.000) and median DFS (36.30 mo vs 25.60 mo, P = 0.001) than patients with surgery alone in the entire cohort. Consistent results with the entire cohort were found in stage II (P = 0.006 and P = 0.047), stage III (P = 0.005 and P = 0.030), and stage IIIB/IIIC patients (P = 0.000 and P = 0.001). The median OS and DFS advantages were confirmed by multivariate analysis (P = 0.000 and P = 0.008) and maintained when the analyses were restricted to fluoropyrimidine monotherapy (P = 0.003 and P = 0.001) and fluoropyrimidine plus platinum regimen (P = 0.001 and P = 0.007), however, not the fluoropyrimidine plus taxane (P = 0.198 and P = 0.777) or platinum plus taxane (P = 0.666 and P = 0.687) regimens. Median OS and median DFS did not differ significantly between the patients with p53(+) and p53(-) tumors (P = 0.608 and P = 0.064), or between patients with CEA(+) and CEA(-) tumors (P = 0.052 and P = 0.989), which were maintained when the analyses were restricted to surgery alone (p53: P = 0.864 and P = 0.431; CEA: P = 0.142 and P = 0.948), adjuvant chemotherapy (p53: P = 0.802 and P = 0.091; CEA: P = 0.223 and P = 0.946) and even different chemotherapy regimens (P > 0.05).
  
  
  CONCLUSIONS
  Patients after D2 gastrectomy for stage II/III gastric adenocarcinoma had significantly better survival after fluoropyrimidine monotherapy and fluoropyrimidine plus platinum. p53 and CEA were not prognostic.
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: He
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Dong-Sheng
authors.initials: DS
authors.lastname: Zhang
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Wang
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wang
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Hui-Yan
authors.initials: HY
authors.lastname: Luo
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ren
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Dong-Liang
authors.initials: DL
authors.lastname: Chen
authors.affiliation: Ming-Ming He, Dong-Sheng Zhang, Feng Wang, Zhi-Qiang Wang, Hui-Yan Luo, Chao Ren, Ying Jin, Dong-Liang Chen, Rui-Hua Xu, State Key Laboratory of Oncology in South China, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
authors.forename: Rui-Hua
authors.initials: RH
authors.lastname: Xu
mesh_terms: D000230:Adenocarcinoma / Q000276:immunology / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
chemical_list: D002272:Carcinoembryonic Antigen; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: Adjuvant chemotherapy; Carcinoembryonic antigen; Gastric adenocarcinoma; Immunohistochemistry; p53