Abstract
BackgroundFor locally advanced gastric cancer (LAGC) with serosal invasion (cT4NxM0), adjuvant chemotherapy (AC) after D2 gastrectomy is the standard therapy in Asia. However, perioperative chemotherapy (PCT) combined with D2 gastrectomy is mostly suggested in Europe and America. As a part of PCT, the value of neoadjuvant chemotherapy (NAC) is unclear. We investigated whether NAC could further improve survival and other outcomes for these patients.MethodsPatients with cT4NxM0 gastric cancer who underwent D2 gastrectomy were analyzed. The patients were divided into two groups based on whether they received NAC: the neoadjuvant chemotherapy (NAC) and direct surgery (S) groups. After propensity score matching (1:1 ratio), survival and perioperative outcomes were analyzed between the two groups.ResultsA total of 902 patients met all the eligibility criteria and were enrolled. After propensity score matching, 221 matched pairs of patients were identified. The median overall survival (OS) and disease-free survival (DFS) of all patients were 75.10 and 43.67 months, respectively. The median OS of patients in the NAC and S groups were undefined and 29.80 months, respectively (P<0.0001). The median DFS of patients in the NAC and S groups were undefined and 22.60 months (P<0.0001). There were no significant differences in the radical degrees of operation between the two groups (P=0.07). However, there were significant differences in postoperative hospital stay (P<0.001) and complications (P=0.037) between the two groups.ConclusionThis study suggested NAC can further improve prognosis and prevent recurrence in LAGC (cT4NxM0) patients. NAC is feasible and safe for LAGC (cT4NxM0) patients, and does not increase the risk of perioperative surgery.
Highlights
Gastric cancer (GC) is one of the most common malignant tumors worldwide, with a high incidence and mortality rate
From our electronic medical record system which included all patients admitted to our gastric cancer professional group, we investigated 3228 patients with primary gastric cancer and without a history of other malignancies at Ruijin Hospital (Shanghai Jiao Tong University School of Medicine, Shanghai, China) between January 2013 and December 2018
The inclusion criteria were as follows: [1] pathologically proven gastric adenocarcinoma by gastroscopy before any treatment, [2] patients aged under 80 years old at their first gastroscopy, [3] patients without any antitumor therapy, [4] patients who provided consent for our treatment, [5] patients with pretreatment CT in our hospital, [6] patients with serosal invasion and without distant metastasis, [7] patients with no digestive tract obstruction, [8] patients with no active gastrointestinal bleeding, and [9] patients who underwent D2 gastrectomy and adjuvant chemotherapy (AC)
Summary
Gastric cancer (GC) is one of the most common malignant tumors worldwide, with a high incidence and mortality rate. GC is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide [1]. For advanced gastric cancer (AGC) with distant metastasis, comprehensive treatment based on systemic antitumor therapy is recommended to prolong the survival and improve the quality of life of patients [8,9,10]. For locally advanced gastric cancer (LAGC), over the past few decades, the standard therapy has been D2 gastrectomy followed by adjuvant chemotherapy (AC), which was confirmed by several randomized controlled trials (RCTs) to improve disease-free survival (DFS) and overall survival (OS) compared with surgery alone [11, 12]. For locally advanced gastric cancer (LAGC) with serosal invasion (cT4NxM0), adjuvant chemotherapy (AC) after D2 gastrectomy is the standard therapy in Asia. We investigated whether NAC could further improve survival and other outcomes for these patients
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