Journal of Gastric Cancer

  • 제16권2호
  • /
  • Pages.105-110
  • /
  • 2016
  • /
  • 2093-582X(pISSN)
  • /
  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지
DOI QR코드

DOI QR Code

The Influence of Metastatic Lymph Node Ratio on the Treatment Outcomes in the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) Trial: A Phase III Trial

  • Kim, Youjin (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Se Hoon (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyoung-Mee (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Min Gew (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jun Ho (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sohn, Tae Sung (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Bae, Jae Moon (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Su Jin (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Seung Tae (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jeeyun (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Joon Oh (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Young Suk (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Ho Yeong (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Won Ki (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2016.04.28
  • 심사 : 2016.05.20
  • 발행 : 2016.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: In the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) trial, we investigated whether chemoradiotherapy after D2 gastrectomy reduces the rate of recurrence. Recently, the ratio of metastatic lymph nodes to examined lymph nodes (N ratio) has been proposed as an independent prognostic factor in gastric cancer (GC). The aim of this study was to investigate the relationship between the metastatic N ratio and prognosis of GC after curative D2 surgery. Materials and Methods: We retrospectively reviewed the data of 458 ARTIST patients who underwent D2 gastrectomy followed by adjuvant chemotherapy (XP, n=228) or chemoradiotherapy (XPRT, n=230). The disease-free survival (DFS) rates of patients were used to evaluate the influence of N ratio on the treatment outcome. To achieve this, 4 different N ratio categories (0%, 1%~9%, 10%~25%, and >25%) were compared on the basis of their influence on the treatment outcome. Results: On multivariate analysis, the N ratio remained an independent prognostic factor for DFS. The hazard ratios (HRs) for the N ratio categories of 0%, 1%~9%, 10%~25%, and >25% were 1, 1.061, 1.202, and 3.571, respectively. In patients having N ratio >25%, the 5-year DFS rates were 55% and 28% for the XPRT and XP arms, respectively (HR, 0.527; 95% confidence interval, 0.307~0.904; P=0.020). Conclusions: In patients with curatively resected GC, the N ratio was independently associated with DFS. Although this finding warrants further investigation in future prospective studies, the benefit of chemoradiotherapy for D2 resected GC appears to be more beneficial in cancers having N ratios >25%.

키워드

참고문헌

  1. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439-449. https://doi.org/10.1016/S1470-2045(10)70070-X
  2. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;29:4387-4393. https://doi.org/10.1200/JCO.2011.36.5908
  3. Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an openlabel, randomised phase 3 trial. Lancet Oncol 2014;15:1389-1396. https://doi.org/10.1016/S1470-2045(14)70473-5
  4. Lee J, Lim do H, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol 2012;30:268-273.
  5. Park SH, Sohn TS, Lee J, Lim do H, Hong ME, Kim KM, et al. Phase III trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer: final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses. J Clin Oncol 2015;33:3130-3136. https://doi.org/10.1200/JCO.2014.58.3930
  6. Ajani JA, Bentrem DJ, Besh S, D'Amico TA, Das P, Denlinger C, et al. Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw 2013;11:531-546. https://doi.org/10.6004/jnccn.2013.0070
  7. Marchet A, Mocellin S, Ambrosi A, de Manzoni G, Di Leo A, Marrelli D, et al. The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol 2008;34:159-165. https://doi.org/10.1016/j.ejso.2007.04.018
  8. Costa Junior WL, Coimbra FJ, Batista TP, Ribeiro HS, Diniz AL. Evaluation of N-ratio in selecting patients for adjuvant chemoradiotherapy after D2-gastrectomy. Arq Gastroenterol 2013;50:257-263. https://doi.org/10.1590/S0004-28032013000400004
  9. Nitti D, Marchet A, Olivieri M, Ambrosi A, Mencarelli R, Belluco C, et al. Ratio between metastatic and examined lymph nodes is an independent prognostic factor after D2 resection for gastric cancer: analysis of a large European monoinstitutional experience. Ann Surg Oncol 2003;10:1077-1085. https://doi.org/10.1245/ASO.2003.03.520
  10. Coimbra FJ, Costa WL Jr, Montagnini AL, Diniz AL, Ribeiro HS, Silva MJ, et al. The interaction between N-category and Nratio as a new tool to improve lymph node metastasis staging in gastric cancer: results of a single cancer center in Brazil. Eur J Surg Oncol 2011;37:47-54. https://doi.org/10.1016/j.ejso.2010.11.002
  11. Kunisaki C, Shimada H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Clinical impact of metastatic lymph node ratio in advanced gastric cancer. Anticancer Res 2005;25:1369-1375.
  12. Lee CM, Park SS, Kim JH. Current status and scope of lymph node micrometastasis in gastric cancer. J Gastric Cancer 2015;15:1-9. https://doi.org/10.5230/jgc.2015.15.1.1

피인용 문헌

  1. Adjuvant radiochemotherapy in locally advanced gastric cancer : Treatment results and analysis of possible prognostic factors vol.193, pp.12, 2016, https://doi.org/10.1007/s00066-017-1173-2
  2. Lymph node ratio is associated with adverse clinicopathological features and is a crucial nodal parameter for oral and oropharyngeal cancer vol.7, pp.None, 2016, https://doi.org/10.1038/s41598-017-07134-7
  3. Optimal management of resected gastric cancer vol.10, pp.None, 2016, https://doi.org/10.2147/cmar.s151552
  4. Between evidence and new perspectives on the current state of the multimodal approach to gastric cancer: Is there still a role for radiation therapy? vol.10, pp.9, 2018, https://doi.org/10.4251/wjgo.v10.i9.271
  5. Results from the safety interim analysis of the adjuvant chemoradiotherapy in stomach tumors 2 trial: a multicenter, randomized phase III clinical trial vol.3, pp.1, 2019, https://doi.org/10.23838/pfm.2018.00177
  6. Prognostic and Predictive Factors for the Curative Treatment of Esophageal and Gastric Cancer in Randomized Controlled Trials: A Systematic Review and Meta-Analysis vol.11, pp.4, 2019, https://doi.org/10.3390/cancers11040530
  7. Lymph-node ratio is an important clinical determinant for selecting the appropriate adjuvant chemotherapy regimen for curative D2-resected gastric cancer vol.145, pp.8, 2016, https://doi.org/10.1007/s00432-019-02963-7
  8. Optimizing adjuvant therapies for the treatment of gastric cancer: with a special focus on Asia vol.19, pp.11, 2016, https://doi.org/10.1080/14737140.2019.1685877
  9. Efficacy of capecitabine and oxaliplatin versus S-1 as adjuvant chemotherapy in gastric cancer after D2 lymph node dissection according to lymph node ratio and N stage vol.19, pp.1, 2016, https://doi.org/10.1186/s12885-019-6433-3
  10. Towards Personalization in the Curative Treatment of Gastric Cancer vol.10, pp.None, 2016, https://doi.org/10.3389/fonc.2020.614907
  11. Comparison of Treatment Modalities for Locally Advanced Gastric Cancer: A Propensity Score Matching Analysis vol.11, pp.15, 2020, https://doi.org/10.7150/jca.41082
  12. High‐risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer vol.49, pp.8, 2016, https://doi.org/10.1111/jop.13043
  13. The Poor Prognosis of Patients with Stage III Gastric Cancer after D2 Dissection Is Mainly due to Lymphatic Metastasis, Especially the Metastasis of No.12a LN: A Nested Case-Control Study vol.44, pp.6, 2021, https://doi.org/10.1159/000512934
  14. Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN) vol.13, pp.6, 2021, https://doi.org/10.3390/cancers13061304