Prognostic factors and adjuvant chemotherapy efficacy in stage I gastric cancer patients: a retrospective analysis

Abstract

Background

Although stage I gastric cancer (GC) presents a favorable survival rate, outcomes for patients experiencing recurrence remain poor. This research focuses on assessing the prognosis and identifying risk factors for stage I GC patients, further assessing the necessity of adjuvant chemotherapy (AC).

Methods

The study involved a retrospective analysis of 902 patients with stage I GC who received curative resection from November 2010 to December 2020. Independent prognostic factors were identified using multivariate Cox regression analysis. Kaplan-Meier analysis was employed to compare recurrence-free survival (RFS) and disease-specific survival (DSS) across different groups.

Results

During follow-up, 47 patients (5.2%) experienced recurrence or death, with the 3-, 5-, and 10-year survival rates exceeding 90%. Age ≥ 65 years and pT2 stage were independently associated with decreased RFS, while age ≥ 65 years, pT2 stage, and tumor diameter ≥ 5 cm was significantly associated with decreased DSS. Patients with an increasing number of risk factors exhibited lower 5-year RFS [97.4% (risk factors = 0) vs. 91.3% (risk factors = 1) vs. 85.0% (risk factors = 2) vs. 63.6% (risk factors = 3); P < 0.001] and DSS [97.5% (risk factors = 0) vs. 92.7% (risk factors = 1) vs. 85.1% (risk factors = 2) vs. 72.9% (risk factors = 3); P < 0.001]. The AC group had lower DSS for patients without risk factors than the non-AC group. However, there was no significant difference in survival outcomes among patients with risk factors between the AC and non-AC groups.

Conclusion

Stage I GC patients exhibited excellent long-term outcomes post-curative resection. Independent prognostic factors included age, pT stage, and tumor diameter. AC failed to provide any additional survival advantage for these patients.