J Gastric Cancer.  2018 Dec;18(4):348-355. 10.5230/jgc.2018.18.e34.

Adjuvant Chemotherapy with or without Concurrent Radiotherapy for Patients with Stage IB Gastric Cancer: a Subgroup Analysis of the Adjuvant Chemoradiotherapy in Stomach Tumors (ARTIST) Phase III Trial

• Kim Y
• Kim KM
• Choi MG
• Lee JH
• Sohn TS
• Bae JM
• Kim S
• Lee SJ
• Kim ST
• Lee J
• Park JO
• Park YS
• Lim HY
• Kang WK
• Park SH

• KMID: 2429881
• DOI: http://doi.org/10.5230/jgc.2018.18.e34

Abstract

PURPOSE
We aimed to discuss the roles of radiation and chemotherapy as adjuvant treatment in patients with staged IB GC who were enrolled in the adjuvant chemoradiotherapy in stomach tumors (ARTIST) trial.
MATERIALS AND METHODS
Among the 458 patients who were enrolled in the ARTIST trial, 99 had stage IB disease. The patients were randomly assigned to receive either adjuvant chemoradiotherapy with capecitabine plus cisplatin (XP, n=50) or chemoradiotherapy (XPRT, n=49). Survival analyses were performed in accordance with the AJCC 2010 staging system.
RESULTS
According to the AJCC 2010 system, stage migration from IB to II occurred in 71% of the patients; 98% of the T2 N0 cases were reclassified as T3 N0, and 42% of the T1 N1 cases were reclassified as T1 N2. When comparing survival outcomes between the XPRT and XP arms for stage IB cancer (AJCC 2002), no significant difference in 5-year disease-free survival (DFS) between the 2 arms was found. (median 5-year DFS, not reached, P=0.256). The patients classified as having stage IB cancer (AJCC 2002) and reclassified as having stage II cancer (AJCC 2010) exhibited worse prognoses than those who remained in stage IB, although the difference was not statistically significant (5-year DFS rate, 83% vs. 93%). When we compared 5-year DFS in 70 patients with stage II (AJCC 2010), the addition of radiotherapy to XP chemotherapy did not show better outcome than XP alone (P=0.137).
CONCLUSIONS
The role of adjuvant chemoradiotherapy in the treatment of stage IB GC (AJCC 2002) warrants further investigation.

Keyword

Gastric cancer; Chemoradiotherapy, Adjuvant

MeSH Terms

Arm
Capecitabine
Chemoradiotherapy
Chemoradiotherapy, Adjuvant*
Chemotherapy, Adjuvant*
Cisplatin
Disease-Free Survival
Drug Therapy
Humans
Prognosis
Radiotherapy*
Stomach Neoplasms*
Stomach*
Capecitabine
Cisplatin

Figure

• 

  Fig. 1 Flow diagram of 99 patients with stage IB disease. ARTIST = adjuvant chemoradiotherapy in stomach tumors; AJCC = American Joint Committee on Cancer; XP = capecitabine plus cisplatin; XPRT = xanthine phosphoribosyltransferase.

• 

  Fig. 2 DFS according to pathological staging using the AJCC 2010 staging system. DFS = disease-free survival; AJCC = American Joint Committee on Cancer.

• 

  Fig. 3 (A) DFS in the XPRT and XP arms of the stage IB group according to pathological staging using the AJCC 2002 system (P=0.256). (B) Comparison of OS between the XPRT and XP arms of the stage IB group according to pathological staging using the AJCC 2002 staging system (P=0.683). (C) Comparison of DFS between the XPRT and XP arms of the stage IB group according to pathological staging using the AJCC 2010 staging system (P=0.900). (D) Comparison of DFS between the XPRT and XP arms of the stage II group according to pathological staging using the AJCC 2010 system (P=0.137). DFS = disease-free survival; XP = capecitabine plus cisplatin; XPRT = xanthine phosphoribosyltransferase; OS = overall survival; AJCC = American Joint Committee on Cancer.

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