pISSN : 2093-582X, eISSN : 2093-5641 J Gastric Cancer 2016;16(2):105-110 http://dx.doi.org/10.5230/jgc.2016.16.2.105
Original Article
The Influence of Metastatic Lymph Node Ratio on the Treatment Outcomes in the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) Trial: A Phase III Trial Youjin Kim, Se Hoon Park, Kyoung-Mee Kim1, Min Gew Choi2, Jun Ho Lee2, Tae Sung Sohn2, Jae Moon Bae2, Sung Kim2, Su Jin Lee, Seung Tae Kim, Jeeyun Lee, Joon Oh Park, Young Suk Park, Ho Yeong Lim, and Won Ki Kang Division of Hematology-Oncology, Department of Medicine, 1Department of Pathology, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2
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%. Key Words: Stomach neoplasms; Lymph node; Prognosis
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Correspondence to: Se Hoon Park Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-1767, Fax: +82-2-3410-1754 E-mail:
[email protected] Received April 28, 2016 Revised May 16, 2016 Accepted May 20, 2016
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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyrights © 2016 by The Korean Gastric Cancer Association
www.jgc-online.org
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Materials and Methods
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Table 1. Baseline patient characteristics
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Characteristic Age (yr)
Data
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N ratio (%)
91/20
Adjuvant treatment
HR
95% CI
Overall survival
P-value
HR
95% CI
P-value
XP
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0
1
XPRT
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0
6
12
18
24
30
36
42
48
54
60
Months
Fig. 1. (A) Disease-free survival curves according to N ratio. (B) Overall survival curves according to N ratio. The cut-off values for the N ratios are as follows: solid (black) line, 0%; dashed line, 1~9%; dotted line, 10~25%; and solid (gray) line, ⾚25%. N ratio = the ratio of metastatic lymph nodes to examined lymph nodes.
108 Kim Y, et al.
A
B
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1.0
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0.8
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Probability
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54
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Months
30
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48
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Fig. 2. (A) Disease-free survival curves for patients with N ratios of 0%~25%. (B) Overall survival curves for patients with N ratios of 0%~25%. Solid line, XPRT arm; dotted line, XP arm. XP = capecitabine plus cisplatin; XPRT = concurrent chemoradiotherapy with XP; N ratio = the ratio of metastatic lymph nodes to examined lymph nodes.
A
B
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1.0
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Probability
Probability
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54
60
Months
0.6 0.4 0.2 0
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6
12
18
24
30
36
42
48
54
60
Months
Fig. 3. (A) Disease-free survival curves for patients with N ratios >25% (B) Overall survival curves for patients with N ratios >25%. Solid line, XPRT arm; dotted line, XP arm. XP = capecitabine plus cisplatin; XPRT = concurrent chemoradiotherapy with XP; N ratio = the ratio of metastatic lymph nodes to examined lymph nodes.
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Conflicts of Interest
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References
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