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International Journal of Surgical Oncology
Volume 2012 (2012), Article ID 307670, 7 pages
http://dx.doi.org/10.1155/2012/307670
Research Article

Survival Benefit of Adjuvant Radiation Therapy for Gastric Cancer following Gastrectomy and Extended Lymphadenectomy

1Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
2Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
3Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
4Vanderbilt Ingram Cancer Center, Nashville, TN 37232-6860, USA
5Division of Surgical Oncology, Vanderbilt University Medical Center, 597 Preston Research Building, Nashville, TN 37232, USA

Received 30 January 2012; Accepted 6 May 2012

Academic Editor: Lapo Bencini

Copyright © 2012 R. A. Snyder et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. Although randomized trials suggest a survival benefit of adjuvant chemotherapy and radiation therapy (XRT) for gastric adenocarcinoma, its use in patients who undergo an extended lymphadenectomy is less clear. The purpose of this study was to determine if a survival benefit exists in gastric cancer patients who receive adjuvant XRT following resection with extended lymphadenectomy. Methods. The SEER registry was queried for records of patients with resected gastric adenocarcinoma from 1988 to 2007. Multivariable Cox regression models were used to assess independent prognostic factors affecting overall survival (OS) and disease-specific survival (DSS). Results. Of 15,060 patients identified, 3,208 (21%) received adjuvant XRT. Adjuvant XRT was independently associated with improved OS (HR 0.67, CI 0.64–0.71) and DSS (HR 0.69, CI 0.65–0.73) in stages IB through IV (M0). This OS and DSS benefit persisted regardless of the extent of lymphadenectomy. Furthermore, lymphadenectomy with >25 LN resected was associated with improved OS and DSS compared with <15 LN or 15–25 LN. Conclusion. This population-based study shows a survival benefit of adjuvant XRT following gastrectomy that persists in patients who have an extended lymphadenectomy. Furthermore, removal of >25 LNs results in improved OS and DSS compared with patients who have fewer LNs resected.