NEW YORK (Reuters Health) – In patients with locally advanced gastric cancer (LAGC), the lymph node ratio (LNR) has value in determining which patients benefit from adjuvant chemotherapy (AC), a new study suggests.
The researchers found that receipt of AC after neoadjuvant chemotherapy (NAC) and curative-intent gastrectomy was associated with improved prognosis in patients with LNR of 9% or greater.
Whether AC can improve the outcome of patients with LAGC after NAC remains a matter of debate, say Dr. Jian-Xian Lin with Fujian Medical University Union Hospital in China and colleagues in JAMA Network Open.
To investigate, they compared survival rates between patients with LAGC who did and did not receive AC after NAC followed by curative-intent surgery.
Among 353 Chinese patients, 262 (74%) received AC and 91 (26%) did not.
After propensity-score matching, the three-year overall survival rate was significantly higher in patients who received AC (60% vs. 49%; P=0.02).
But LNR mattered. At an LNR of 9% or higher, receipt of AC was significantly associated with improved three-year overall survival compared with no AC (47% vs. 22%; P<0.001). At an LNR below 9%, however, there was no significant improvement in three-year overall survival with AC compared with no AC (74% vs. 71%; P=0.30).
An external validation cohort of 109 patients from the U.S. and Italy also confirmed improved overall survival with AC administration at an LNR of 9% or greater (53% vs. 26%; P=0.04).
When stratified by AC cycles, only patients who completed at least four cycles of AC had a significant survival benefit in the six-month analysis (hazard ratio 0.56; P=0.03) and nine-month analysis (HR, 0.50; P=0.03).
“Lymph node ratio may be used as an adjunct in clinical decision-making regarding AC planning in this patient population. Additional studies are needed to confirm these findings,” the study team concludes.
SOURCE: https://bit.ly/3NHHwRS JAMA Network Open, online April 1, 2022.
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