Abstract
Background
Neoadjuvant chemotherapy (NAC) is increasingly used in locally advanced gastric cancer (LAGC), but the clinical safety and efficacy are still controversial. This study aims to compare perioperative chemotherapy (PEC) with adjuvant chemotherapy (AC) for resectable LAGC.
Methods
Patients who underwent D2 gastrectomy for resectable LAGC were retrospectively reviewed, and divided into NSA group (NAC plus surgery and AC) and SA group (surgery followed by AC). The baseline characteristics and perioperative data were compared. Survival analysis was based on Kaplan–Meier method. Multivariate analyses for prognostic factors were based on the Cox regression.
Results
A total of 450 patients were eligible for this study. 218 patients received NAC plus surgery and AC, while 232 upfront surgery followed by AC. The baseline characteristics were comparable between the two groups. NSA group showed significant superiority in R0 resection rate (P = 0.014), excised tumor size (P = 0.038), and tumor downstage (all P < 0.001). NAC did not affect postoperative complications or AC-related grade 3/4 adverse events. Patients in NSA group achieved significantly longer OS (P = 0.021) and DFS (P = 0.002). The Cox regression model showed that NAC was independently associated with better OS (HR 0.245, P = 0.039) and DFS (HR 0.591, P = 0.031).
Conclusions
Compared with SA, the administration of NSA was considered safe and feasible for achieving higher R0 resection rate without increasing the postoperative complications or AC-related grade 3/4 adverse events, and NAC was independently associated with better OS and DFS for resectable LAGC.
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Introduction
Gastric cancer (GC) is the fifth most frequently diagnosed malignancy, accounting for the third leading cause of cancer-related death worldwide [1]. Due to the lack of typical clinical symptoms in early GC, most patients have progressed to the advanced stage at the initial diagnosis [26]. It was worth noting that there was no significant difference in postoperative outcomes and complications between the two groups. This result further confirmed the safety of the perioperative treatment pattern.
There have been currently no unified standard indications for the application of neoadjuvant chemotherapy in LAGC. The Japan Clinical Oncology Group suggested that LAGC patients with clinical T3/T4 and cN+ stage were suitable to receive neoadjuvant chemotherapy [27]. The indications of neoadjuvant chemotherapy for GC in the 2021 Chinese Society of Clinical Oncology (CSCO) guidelines were patients with clinical staging T3–4a and N+ stage [28]; whereas, the ESMO clinical practice guidelines recommended a wider range of indications for neoadjuvant chemotherapy (> cT1N0) [29]. Survival benefits might be brought to patients in the condition of formulating suitable criteria to select the right people and using individualized and suitable treatment. In addition, well-designed studies are required to explore effective chemotherapy regimens and cycles. Precise staging and timely identification of the pathological response would lead to either an intensification of the neoadjuvant strategy in responding patients or to consider surgical treatment in the absence of clinical benefit.
We acknowledge that the present study contains certain limitations. Due to its retrospective nature and relatively limited number of patients at a single institution, potential selection bias and excessive hazard ratios in the analysis might exist. Second, even chemotherapy regimen was basically based on platinum drugs and 5-fluorouracil regimens, it was not standardized for NAC or AC, the effects of different regimens were not analyzed. Third, the patient cohort is a selected group (all had undergone resection and AC), and thus, the conclusion could not be extrapolated to all LAGC patients. Finally, our follow-up was relatively short. Despite the limitations above, the present study verified the superiority of perioperative chemotherapy for Asian patients with LAGC to a certain extent.
Conclusions
Compared with SA, the administration of NSA was considered safe and feasible for achieving higher R0 resection rate without increasing the postoperative complications or AC-related grade 3/4 adverse events, and NAC was independently associated with better OS and DFS for resectable LAGC. Our findings are expected to be supported by more high-quality prospective data.
Availability of data and materials
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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This research was supported by National High Level Hospital Clinical Research Funding (Grant No. 2022-PUMCH-B-005). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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PS and JY designed the study and wrote the manuscript; LJ, YZ, TY and HH contributed to the patient material; PS, LJ, MC and CC collected the clinical data; WK and YL contributed to data analysis and validation. All authors have reviewed and approved the final manuscript.
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Su, P., Jiang, L., Zhang, Y. et al. Perioperative chemotherapy versus adjuvant chemotherapy treatment for resectable locally advanced gastric cancer: a retrospective cohort study. Eur J Med Res 28, 409 (2023). https://doi.org/10.1186/s40001-023-01400-3
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DOI: https://doi.org/10.1186/s40001-023-01400-3