| Background and Objective:Because of the staying highly incidence and mortality of gastric cancer worldwide,it is still a world problem to improve the survival prognosis.Although the surgical treatment is crucial,the highly postoperative recurrence rate seriously affects the gastric cancer survivors,therefore,various adjuvant therapies are particularly important.The role of chemo?radiotherapy based on 5-FU of gastric cancer postoperative adjuvant treatment had been established when the results of the INT-0116 randomized controlled study reported by the New England Journal in 2001.However,the question about postoperative adjuvant chemo?radiotherapy of gastric cancer whether to benefit patients is still much controversy in the world.This study objects to investigate whether postoperative chemo?radiotherapy of gastric cancer can improve the survival patients and the difference efficacy of chemo?radiotherapy among different subgroups with differentlymph node detection status.Methods:Retrospective analysis the postoperative patients with gastric adenocarcinoma base on the database of SEER(Surveillance,Epidemiology,and End Results)from 2004 to 2013 with stage IB to ?C(The seventh edition of American Joint Committee on Cancer stage,AJCC).The cases were divided into three groups:surgery group,chemotherapy group and chemo?radiotherapy(CRT)group according to the types of postoperative adjuvant therapy.According to the number of lymph nodes examined(NLNE),there are divided into three subgroups:NLNE 0-15.NLNE16-30 and NLNE>30.The survival differences between the groups were compared by Kaplan?Meier.The independent factors affecting prognosis were analyzed by applying the Cox proportional hazard model.Results:A total of 12.988 patients were included in the study according to the entering criteria,totally have 6072 patients in surgery group,2611 in chemotherapy group and 4305 in CRT group.KM analysis results showed that postoperative CRT can significantly improve the survival prognosis.Patients of the CRT group compared with Chemotherapy group and Surgery group:the 5?wear Overalll Survival(OS)40.5%was superior to the 33.3%and the 28.8%,the Median Survival(MS)time 39m was superior to 29m and the 22m.among groups P<0.001,for the 5 years Cancer-Specific Survival(CSS)45.7%was superior to 38.0%and the 38.2%,the MS 46m was superior to 33m and 28m in sequence,among groups P<0.001.By reference to the 2018 CSCO Guidelines for Gastric Cancer,we performed a subgroup analysis by the NLNE.When the NLNE was 0?15,the 5 years OS of CRT group 37.2&was superior to the Chemotherapy group 313%and the Surgery group 27.3%.the MS 35m was superior to 26m and 21m in sequence,among groups P<0.001;When NLNE was 16 to 30,the 5 years OS of CRT group 43.1%was superior to the Chemotherapy group 32.0%and the Surgery group 29.9%,the MS 45m was superior to 29m and 23m in sequence,among groups P<0.001:When NLNE>30.the 5vears OS of CRT group 45.5% was superior to the Chemotherapy group 41.8%and the Surgery group 34.2%,the MS 45m was superior to 38m and 23m in sequence.Although the CRT group and Chemotherapy group improve the survival prognosis,P<0.001,the CRT group and the Chemotherapy have no statistical efficiency difference(P=0.302).According to the results of KM survival curve,the factors of postoperative treatment plan,age,sex,race,tumor grade,tumor stage,surgery type,NLNE and pathological type were regression analyzed in COX.Finally,getting the conclusion whic h the factors of treatment plan,age.race,tumor grade,tumor stage,surgery type,NLNE and pathological type are independent factors effecting the postoperative survival of patients.Compared with postoperative chemotherapy,the risk of death increased in the surgery group only,Hazard Ratio(HR)=1.598.95%CI(Confidence Interval)=1.498?1.705,P<0.001,while the postoperative CRT can significantly reduce the risk of death.HR=0.789,95%CI=0.738?0.844,P<0.001.When the NLNE was 0?15,factors above were regression analyzed in COX.the risk of death of CRT group war lower than the Chemotherapy group HR=0.793.95%CI=0.719?0.874.P?0.001.When the NLNE was 16 to 30.the risk of death of CRT group was lower than the Chemotherapy group HR=0.761.95%CI=0,682?0.849,P<0.001.Conclusion:Through the analysis of the three groups and get conclusions that:(1)The postoperative CRT was superior to the OS and CSS for gastric cancer patients.And the analysis results of COX suggest that the postoperative CRT is a prognosis independent factor.(2)When the NLNE is 0?15 of patients with stage IB to ?C.the postoperative OS survival of the CRT group was significantly higher than the Chemotherapy group and the Surgery group.(3)When the NLNE is 16 to 30 of patients with stage ?A to ?C.the survival gaining of the CRT group was significantly higher than the Chemotherapy group and the Surgery group.(4)When the NLNE is 30 of the patients.although the CRT group and Chemotherapy group improve the survival prognosis,the CRT group and the Chemotherapy have no statistical efficiency difference compared with the surgery group.(5)Postoperative CRT is an effective and selectable treatment type for gastric cancer.It should be emphasized that this study is a regression analysis which still need to more research on RCT from multicenters. |
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