title: Perioperative chemotherapy versus postoperative chemoradiotherapy in patients with resectable gastric/gastroesophageal junction adenocarcinomas: A survival analysis of 5058 patients.
abstract: BACKGROUND
  Both perioperative chemotherapy (PECT) and postoperative chemoradiotherapy (POCRT) have a significant survival advantage over surgery alone for the treatment of patients with gastric cancer. However, to the best of our knowledge, these regimens have not been compared in a randomized clinical trial. The purpose of the current observational study was to compare overall survival among patients receiving PECT versus POCRT for the treatment of gastric/gastroesophageal junction (GEJ) adenocarcinomas.
  
  
  METHODS
  Patients with resected clinical American Joint Committee on Cancer TNM stage II or III adenocarcinomas of the stomach or GEJ from 2004 through 2013 were identified utilizing the National Cancer Data Base. Hazard ratios (HRs), 95% confidence intervals, and P values were computed using a Cox proportional hazards procedure. Multivariable models were adjusted for treatment regimen, age, race, ethnicity, tumor size, TNM stage, Charlson comorbidity index, and tumor grade.
  
  
  RESULTS
  Patients receiving PECT had a 72% survival advantage compared with those treated with POCRT (5058 patients; HR, 0.58 [adjusted P<.0001]). The 5-year actuarial survival rate for PECT was 44% compared with 38% for POCRT. A statistically significant survival advantage for PECT also was observed when the analysis was stratified by clinical stage of disease (stage II [3192 patients]: adjusted HR, 0.79 [P = .041]; and stage III [1866 patients]: adjusted HR, 0.49 [P<.0001]). This benefit was greatest among patients with lymph node-positive disease who converted to lymph node-negative status with PECT.
  
  
  CONCLUSIONS
  In this large series of patients with stage II/III resected gastric/GEJ adenocarcinomas from >1500 American College of Surgeons Commission on Cancer-accredited facilities, patients receiving PECT were shown to survive longer than those receiving POCRT. Cancer 2017;123:2909-17. © 2017 American Cancer Society.
authors.affiliation: Surgical Oncology, Maine Medical Center Cancer Institute, Scarborough, Maine.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Leo W. Jenkins Cancer Center, Vidant Medical Center, East Carolina University, Greenville, North Carolina.
authors.forename: Jimmy T
authors.identifier: http://orcid.org/0000-0002-4890-5111
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Department of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Nelly
authors.initials: N
authors.lastname: Bellamy
authors.affiliation: Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Russo
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Charulata
authors.initials: C
authors.lastname: Jindal
authors.affiliation: Department of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Catalina
authors.initials: C
authors.lastname: Mosquera
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Holliday
authors.affiliation: Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Tithi
authors.initials: T
authors.lastname: Biswas
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D019990:Perioperative Care; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis
keywords: adenocarcinoma; gastric cancer; gastroesophageal junction; perioperative chemotherapy; postoperative chemoradiotherapy