{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T02:27:41Z","timestamp":1740104861314,"version":"3.37.3"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T00:00:00Z","timestamp":1682640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with resectable noncardia gastric cancer may be subjected to perioperative chemotherapy (PEC), postoperative chemoradiation (POCR), or postoperative chemotherapy (POC). We analyzed these treatment strategies to determine optimal therapy based on nodal status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The National Cancer Database was used to identify patients with resected noncardia gastric cancer (2004\u20132016). Patients were stratified based on clinical nodal status\u2013negative (cLN\u2212), positive (cLN+) and pathological nodal status (pLN\u2212, pLN+). In cLN\u2212 patients who underwent upfront resection and were upstaged to pLN+, POC, and POCR were compared. Overall survival (OS) with PEC, POCR, and POC were compared in cLN\u2212 and cLN+.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 6142 patients (cLN\u2212: 3831; cLN+: 2311). In cLN\u2212 patients who underwent upfront resection (<jats:italic>N<\/jats:italic>\u2009=\u20093423), 69% were upstaged to pLN+ disease (<jats:italic>N<\/jats:italic>\u2009=\u20092499; POCR\u2009=\u20091796, POC\u2009=\u2009703). On MVA, POCR was associated with significantly improved OS when compared to POC (hazard ratio [HR]: 0.75; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><jats:p>In patients with cLN\u2212 disease (PEC\u2009=\u2009408; POCR\u2009=\u20092439; POC\u2009=\u2009984), PEC(HR: 0.77; <jats:italic>p<\/jats:italic>\u2009=\u20090.01) and POCR(HR: 0.81; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) were associated with improved OS compared with POC. In cLN+ group (PEC\u2009=\u2009452; POCR\u2009=\u20091284; POC\u2009=\u2009575), POCR was associated with improved OS compared with POC (HR: 0.81; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and trend towards improved OS was noted when PEC(HR: 0.83; <jats:italic>p<\/jats:italic>\u2009=\u20090.055) was compared with POC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postoperative chemoradiation may be the preferred treatment strategy over postoperative chemotherapy in non\u2010cardia gastric cancer patients who receive upfront resection and are upstaged from clinically node negative to pathologically node positive disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27297","type":"journal-article","created":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T08:18:47Z","timestamp":1682669927000},"page":"242-253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of nodal status in determining multimodal treatment strategies in non\u2010cardia gastric cancer"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9292-8345","authenticated-orcid":false,"given":"Pranay S.","family":"Ajay","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin P.","family":"Sok","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Subir","family":"Goyal","sequence":"additional","affiliation":[{"name":"Biostatistics Shared Resource, Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffery M.","family":"Switchenko","sequence":"additional","affiliation":[{"name":"Biostatistics Shared Resource, Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe B.","family":"Maegawa","sequence":"additional","affiliation":[{"name":"Division of General and Gastrointestinal Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa W.","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Winship Cancer Institute Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chrystal M.","family":"Paulos","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory B.","family":"Lesinski","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology, Winship Cancer Institute Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-0455","authenticated-orcid":false,"given":"David A.","family":"Kooby","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey Rutgers University  New Brunswick New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4665-5534","authenticated-orcid":false,"given":"Mihir M.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,28]]},"reference":[{"journal-title":"Cancer Stat Facts: Stomach Cancer","article-title":"Surveillance, epidemiology and end results program","author":"National Cancer 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