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Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center

Wilson L Costa1*, Felipe JF Coimbra1, Ricardo C Fogaroli2, Héber SC Ribeiro1, Alessandro L Diniz1, Maria Dirlei FL Begnami3, Celso AL Mello4, Marcelo F Fanelli4, Milton JB Silva4, José Humberto Fregnani5 and André L Montagnini6

Author Affiliations

1 Department of Abdominal Surgery, Hospital A. C. Camargo, Sao Paulo, Brazil

2 Department of Radiotherapy, Hospital A. C. Camargo, Sao Paulo, Brazil

3 Department of Surgical Pathology, Hospital A. C. Camargo, Sao Paulo, Brazil

4 Department of Clinical Oncology, Hospital A. C. Camargo, Sao Paulo, Brazil

5 Center for Researcher Support, Barretos Cancer Hospital, Barretos, Brazil

6 Department of Gastroenterology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil

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Radiation Oncology 2012, 7:169  doi:10.1186/1748-717X-7-169

Published: 15 October 2012



Adjuvant chemoradiotherapy is part of a multimodality treatment approach in order to improve survival outcomes after surgery for gastric cancer. The aims of this study are to describe the results of gastrectomy and adjuvant chemoradiotherapy in patients treated in a single institution, and to identify prognostic factors that could determine which individuals would benefit from this treatment.


This retrospective study included patients with pathologically confirmed gastric adenocarcinoma who underwent surgical treatment with curative intent in a single cancer center in Brazil, between 1998 and 2008. Among 327 patients treated in this period, 142 were selected. Exclusion criteria were distant metastatic disease (M1), T1N0 tumors, different multimodality treatments and tumors of the gastric stump. Another 10 individuals were lost to follow-up and there were 3 postoperative deaths. The role of several clinical and pathological variables as prognostic factors was determined.


D2-lymphadenectomy was performed in 90.8% of the patients, who had 5-year overall and disease-free survival of 58.9% and 55.7%. The interaction of N-category and N-ratio, extended resection and perineural invasion were independent prognostic factors for overall and disease-free survival. Adjuvant chemoradiotherapy was not associated with a significant improvement in survival. Patients with node-positive disease had improved survival with adjuvant chemoradiotherapy, especially when we grouped patients with N1 and N2 tumors and a higher N-ratio. These individuals had worse disease-free (30.3% vs. 48.9%) and overall survival (30.9% vs. 71.4%).


N-category and N-ratio interaction, perineural invasion and extended resections were prognostic factors for survival in gastric cancer patients treated with D2-lymphadenectomy, but adjuvant chemoradiotherapy was not. There may be some benefit with this treatment in patients with node-positive disease and higher N-ratio.