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Prognostic factors and significance of postoperative adjuvant chemotherapy in patients with advanced gastric cancer undergoing neoadjuvant chemotherapy followed by gastrectomy

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Abstract

Purpose

In Japan, gastrectomy with D2 lymph node dissection and postoperative adjuvant chemotherapy are the standard treatments for locally advanced gastric cancer. Neoadjuvant chemotherapy (NAC) is not affected by postgastrectomy syndromes or postoperative complications. This multicenter retrospective study investigated the prognostic factors and significance of postoperative adjuvant chemotherapy in patients with advanced gastric cancer who underwent NAC followed by gastrectomy.

Methods

Consecutive patients (n = 221) with advanced gastric cancer who underwent NAC followed by curative surgery were enrolled in this study. Prognostic factors including postoperative adjuvant chemotherapy were investigated using univariate and multivariate analyses.

Results

A multivariate analysis revealed that pathological lymph node metastasis (ypN) status and postoperative adjuvant chemotherapy were independent prognostic factors for the overall and relapse-free survival. Forty-five patients (20.4%) did not receive postoperative adjuvant chemotherapy. There were no significant differences between patients with and without adjuvant chemotherapy for all factors, except age. The most common reason for not undergoing postoperative adjuvant chemotherapy was a poor condition (n = 23).

Conclusions

ypN status and postoperative adjuvant chemotherapy were independent prognostic factors in gastric cancer patients who underwent NAC followed by curative gastrectomy. It is important to maintain the patient’s condition during NAC and the perioperative period so that they can receive postoperative adjuvant chemotherapy.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.

    Article  PubMed  Google Scholar 

  2. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    Article  CAS  PubMed  Google Scholar 

  3. Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fuorouracil plus leucovorin, oxaliplatin, and docetaxel versus fuorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393:1948–57.

    Article  PubMed  Google Scholar 

  4. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.

    Article  CAS  PubMed  Google Scholar 

  5. Yoshida K, Kodera Y, Kochi M, Ichikawa W, Kakeji Y, Sano T, et al. Addition of docetaxel to oral fluoropyrimidine improves efficacy in patients with stage III gastric cancer: interim analysis of JACCRO GC-07, a randomized controlled trial. J Clin Oncol. 2019;37:1296–304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Yoshikawa T, Sasako M, Yamamoto S, Sano T, Imamura H, Fujitani K, et al. Phase II study of neoadjuvant chemotherapy and extended surgery for locally advanced gastric cancer. Br J Surg. 2009;96:1015–22.

    Article  CAS  PubMed  Google Scholar 

  7. Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014;101:653–60.

    Article  CAS  PubMed  Google Scholar 

  8. Fujitani K, Mano M, Hirao M, Kodama Y, Tsu**aka T. Posttherapy nodal status, not graded histologic response, predicts survival after neoadjuvant chemotherapy for advanced gastric cancer. Ann Surg Oncol. 2012;19:1936–43.

    Article  PubMed  Google Scholar 

  9. Glatz T, Bronsert P, Schäfer M, Kulemann B, Marjanovic G, Sick O, et al. Perioperative platin-based chemotherapy for locally advanced esophagogastric adenocarcinoma: postoperative chemotherapy has a substantial impact on outcome. Eur J Surg Oncol. 2015;41:1300–7.

    Article  CAS  PubMed  Google Scholar 

  10. Drake JA, Stiles ZE, Tsao MW, Deneve JL, Glazer ES, Yakoub D, et al. Analysis of the survival impact of postoperative chemotherapy after preoperative chemotherapy and resection for gastric cancer. Ann Surg Oncol. 2021;28:1417–27.

    Article  PubMed  Google Scholar 

  11. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  12. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  13. Ishigami H, Fujiwara Y, Fukushima R, Nashimoto A, Yabusaki H, Imano M, et al. Phase III trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC trial. J Clin Oncol. 2018;36:1922–9.

    Article  CAS  PubMed  Google Scholar 

  14. Fujitani K, Nakamura K, Mizusawa J, Kuwata T, Shimoda T, Katayama H, et al. Post-therapy topographical nodal status, ypN-site, predicts survival of patients who received neoadjuvant chemotherapy followed by curative surgical resection for non-type 4 locally advanced gastric cancer: supplementary analysis of JCOG1004-A. Gastric Cancer. 2021;24:197–204.

    Article  CAS  PubMed  Google Scholar 

  15. Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AF, Lampis A, et al. Effect of pathologic tumor response and nodal status on survival in the medical research council adjuvant gastric infusional chemotherapy trial. J Clin Oncol. 2016;34:2721–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Schmidt T, Sicic L, Blank S, Becker K, Weichert W, Bruckner T, et al. Prognostic value of histopathological regression in 850 neoadjuvantly treated oesophagogastric adenocarcinomas. Br J Cancer. 2014;110:1712–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Becker K, Langer R, Reim D, Novotny A, Meyer zum Buschenfelde C, Engel J, et al. Significance of histopathological tumor regression after neoadjuvant chemotherapy in gastric adenocarcinomas: a summary of 480 cases. Ann Surg. 2011;253:934–9.

    Article  PubMed  Google Scholar 

  18. Nakamura K, Kuwata T, Shimoda T, Mizusawa J, Katayama H, Kushima R, et al. Determination of the optimal cutoff percentage of residual tumors to define the pathological response rate for gastric cancer treated with preoperative therapy (JCOG1004-A). Gastric Cancer. 2015;18:597–604.

    Article  CAS  PubMed  Google Scholar 

  19. van Putten M, Lemmens VEPP, van Laarhoven HWM, Pruijt HFM, Nieuwenhuijzen GAP, Verhoeven RHA. Poor compliance with perioperative chemotherapy for resectable gastric cancer and its impact on survival. Eur J Surg Oncol. 2019;45:1926–33.

    Article  PubMed  Google Scholar 

  20. Rahman S, Thomas B, Maynard N, Park MH, Wahedally M, Trudgill N, et al. Impact of postoperative chemotherapy on survival for oesophagogastric adenocarcinoma after preoperative chemotherapy and surgery. Br J Surg. 2022;109:227–36.

    Article  PubMed  Google Scholar 

  21. Sisic L, Blank S, Nienhüser H, Haag GM, Jäger D, Bruckner T, et al. The postoperative part of perioperative chemotherapy fails to provide a survival benefit in completely resected esophagogastric adenocarcinoma. Surg Oncol. 2020;33:177–88.

    Article  PubMed  Google Scholar 

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Funding

This study was supported by a grant from the Japanese Gastric Cancer Association.

Author information

Authors and Affiliations

  1. Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan

    Masaaki Motoori & Kazumasa Fujitani

  2. Department of Surgery, Osaka Police Hospital, Osaka, Japan

    Kentaro Kishi & Yujiro Nakahara

  3. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Kazuyoshi Yamamoto, Yukinori Kurokawa & Yuichiro Doki

  4. Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan

    Atsushi Takeno & Takuya Hamakawa

  5. Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan

    Hisashi Hara & Takeshi Omori

  6. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan

    Kohei Murakami & Toru Masuzawa

Authors
  1. Masaaki Motoori
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  2. Kentaro Kishi
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  3. Kazuyoshi Yamamoto
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  11. Yukinori Kurokawa
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  13. Yuichiro Doki
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Corresponding author

Correspondence to Masaaki Motoori.

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Conflict of interest

Yukinori Kurokawa has received lecture fees from Taiho Pharmaceutical, Ono Pharmaceutical, Daiichi Sankyo, Lilly, Nippon Kayaku, and Kaken Pharmaceutical and research grants from Taiho Pharmaceutical, Yakult Honsha, AstraZeneca, Ono Pharmaceutical, and MSD Oncology outside of the submitted work.

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Motoori, M., Kishi, K., Yamamoto, K. et al. Prognostic factors and significance of postoperative adjuvant chemotherapy in patients with advanced gastric cancer undergoing neoadjuvant chemotherapy followed by gastrectomy. Surg Today (2024). https://doi.org/10.1007/s00595-024-02853-7

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