Does non-metastatic gastric cancer of the cardia warrant a different treatment strategy?

Pranay S. Ajay, Rachel NeMoyer, Subir Goyal, Jeffery M. Switchenko, Yong Lin, Salma K. Jabbour, Darren R. Carpizo, Chrystal M. Paulos, Timothy J. Kennedy, Mihir M. Shah

Research output: Contribution to journalArticlepeer-review


Background: Multimodal treatment strategies with surgery as its centerpiece have been accepted as the standard of care in nonmetastatic cardia gastric cancer (CGC). There remains a lack of consensus regarding the optimal multimodal treatment strategy. Method: We queried National Cancer Database from 2004 to 2016 to identify patients with resected nonmetastatic CGC who received perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), or postoperative chemotherapy (POC). A subgroup analysis was performed in optimally treated patients defined as initial chemotherapy within 45 days of diagnosis, resection within 45 days of diagnosis, negative margins, adjuvant chemotherapy within 90 days of resection, and standard radiation dose (45 Gy). Kaplan–Meier, Univariate analysis (UVA), and Multivariable analysis (MVA) were performed. Results: We identified 2387 patients. Median survival was 38.8 months in the PEC group, 36 months in the POCR group, and 32.3 months in the POC group (p = 0.1025). On UVA, patients treated with PEC had an association with improved survival (HR, 0.83; p = 0.037) when compared with POC. On MVA, no significant difference was noted in overall survival (OS) between PEC, POCR, and POC, similar to subgroup analysis of optimally treated cohort. Conclusion: OS rate in nonmetastatic CGC is not significantly different between patients receiving PEC, POCR, or POC.

Original languageEnglish (US)
Pages (from-to)231-241
Number of pages11
JournalJournal of Surgical Oncology
Issue number2
StatePublished - Aug 2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology


  • multimodal treatment in cardia gastric cancer
  • multimodal treatment in gastric cancer
  • nonmetastatic cardia gastric cancer
  • nonmetastatic gastric cancer
  • resectable cardia gastric cancer


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