title: The role of adjuvant chemotherapy for patients with stage II and stage III gastric adenocarcinoma after surgery plus D2 lymph node dissection: a real-world observation.
abstract: BACKGROUND
  The influence of adjuvant chemotherapy on the survival of gastric adenocarcinoma patients in a stage-specific manner is controversial.
  
  
  METHODS
  To further explore this topic, we retrospectively analyzed the impact of adjuvant chemotherapy on the clinical outcomes of 77 stage II and 117 stage III patients diagnosed between January 2008 and December 2012.
  
  
  RESULTS
  All 194 patients underwent radical operation plus D2 dissection, and were followed a median time of 23.3 (range 0.4-80.2) months. Median patient age was 67.7 (range 33.9-97.5) years. Adjuvant chemotherapy prolonged the relapse-free survival [22.9 (95 % confidence interval 9.4-36.4) vs. 14.2 (95 % CI 8.6-19.8) months, P = 0.009] and overall survival [32.3 (95 % CI 22.6-42.0) vs. 13.4 (95 % CI 9.5-17.2) months, P < 0.001] for patients with stage III, but not stage II, disease. Higher overall survival from adjuvant chemotherapy in stage II patients with node involvement did not reach the level of statistical significance (P = 0.102). To reduce the selection bias, 142 patients aged <75 years were included in a subgroup analysis in which the benefit of adjuvant chemotherapy on relapse-free survival and overall survival were demonstrated for patients with stage III disease.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy prolongs relapse-free and overall survival for patients with stage III gastric cancer in a real-world situation. Tailoring therapy based on different characteristics for patients with stage II gastric cancer may produce better outcomes.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40402 Taiwan ; Cancer Center, China Medical University Hospital, Taichung, 40402 Taiwan ; College of Medicine, School of Medicine, China Medical University, Taichung, 40402 Taiwan.
authors.forename: Chang-Fang
authors.initials: CF
authors.lastname: Chiu
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, 40402 Taiwan.
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, 40402 Taiwan.
authors.forename: Mei-Due
authors.initials: MD
authors.lastname: Yang
authors.affiliation: Department of Surgery, China Medical University Hospital, Taichung, 40402 Taiwan.
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.affiliation: Charles River Laboratories, Preclinical Services, Spencerville, OH 45887 USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Sargeant
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40402 Taiwan ; College of Medicine, School of Medicine, China Medical University, Taichung, 40402 Taiwan.
authors.forename: Su-Peng
authors.initials: SP
authors.lastname: Yeh
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, 2, Yude Road, Taichung, 40402 Taiwan ; College of Medicine, School of Medicine, China Medical University, Taichung, 40402 Taiwan.
authors.forename: Li-Yuan
authors.initials: LY
authors.lastname: Bai
keywords: Adjuvant chemotherapy; D2 dissection; Gastrectomy; Gastric cancer; Overall survival; Relapse-free survival