Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer

Jiménez, Juan Ocaña; Priego, Pablo; Cuadrado, Marta; Blázquez, Luis Alberto; Picot, S.; Peinado, Paula Pastor; Longo, Federico; López, F.; Caminoa-Lizarralde, María Alejandra; Galindo, Julio

doi:10.17235/reed.2020.6763/2019

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…Time interval to surgery after the completion of NACT is a common question asked by patients with GC, but it is a question without a definite answer. There have only been a few retrospective studies on this topic with limited sample size, and these have come to different conclusions (10,11,25). Liu et al (10) first presented a retrospective study of 176 patients with GC and proposed that prolonged interval time of >6 weeks was associated with an increased rate of pCR but not with OS or DFS.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

et al. 2020

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BackgroundThe relationship between time to surgery (TTS) and survival benefit is not sufficiently demonstrated by previous studies in locally advanced gastric cancer (LAGC). This study aims to assess the impact of TTS after neoadjuvant chemotherapy (NACT) on long-term and short-term outcomes in LAGC patients.MethodsData were collected from patients with LAGC who underwent NACT between January 2007 and January 2018 at our institution. Outcomes assessed were long-term survival, pathologic complete response (pCR) rate, and postoperative complications.ResultsThis cohort of 426 patients was divided into five groups by weeks of TTS. Under cox regression, compared to other groups, the 22–28 days and 29–35 days groups revealed a better OS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.185; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.004; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.022) and PFS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.256; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.111; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.047). Further analysis revealed a better prognosis in patients with TTS within 22–35 days (OS: HR 1.78 95% CI = 1.25−2.54, P = 0.001; PFS: HR 1.49, 95% CI = 1.07−2.08, P = 0.017). Postoperative stay was significantly higher in the ≤21 days group, while other parameters revealed no statistical significance (P > 0.05). Restricted cubic spline depicted the nonlinear relationship between TTS and OS/PFS.ConclusionPatients who received surgery within 3−5 weeks experienced the maximal survival benefit without an increase in postoperative complications or lowering the rate of pCR. Further investigations are warranted.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

et al. 2020

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“…Ocana et al in their research paper did not use a complete pathological response rate as an outcome because only two patients in their study had pCR. 27 They used tumor response (DS) rates as the outcome and found an increase in DS rates with a longer interval time (>6 weeks) but there was no impact on OS among the three interval time groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis

Shah¹,

Qari²,

Banday³

et al. 2023

Euroasian Journal of Hepato-Gastroenterology

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A bstract Background It is still unknown what is the appropriate time between neoadjuvant chemotherapy (NACT) and gastrectomy in cases of gastric cancer. To comprehend the relationship more clearly between waiting time after NACT before having a gastrectomy and survival results, a meta-analysis was done. Methods Retrospective and prospective research from the PubMed, Embase, and Cochrane Library databases were thoroughly reviewed. Research examining the impact of delays of 4, 4–6, and above 6 weeks between the conclusion of NACT and surgery in patients with locally advanced gastric cancer qualified as eligible studies. The pathologic complete response (pCR) rate served as the main outcome indicator. Additional outcome metrics were overall survival (OS) and survival free of illness. Results The meta-analysis showed that patients with locally advanced gastric cancer with a waiting time for surgery of above 4 weeks compared to those with a waiting time for surgery of below 4 weeks saw a significantly higher pCR rate (pCR) [odds ratio (OR): 1.67; 95% confidence interval (CI): 1.07–2.60; p = 0.02]. The meta-analysis found no appreciable OS differences [hazard ratio (HR): 0.93; 95% CI: 0.76–1.13; p = 0.44). Conclusions Time to surgery (TTS) had no effect on the survival results, according to our data. Only in the group where delaying surgery by more than 4 weeks after the end of NACT improved pathological response, but had no effect on survival. How to cite this article Naveed S, Banday SZ, Qari H, et al . Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis. Euroasian J Hepato-Gastroenterol 2022;12(2):81–91.

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“…A similar result was reported by Juan Ocana et al . from Spain ( 91 ). To have more probabilities to discuss the deep meaning of the NACT-surgery interval time, Wang et al .…”

Section: What Is the Most Important Point In Nat?mentioning

confidence: 99%

Current status and future perspectives on neoadjuvant therapy in gastric cancer

Ao¹,

Wang²,

Song³

et al. 2021

Chinese Journal of Cancer Research

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Gastric cancer, with high morbidity and mortality rates, is one of the most heterogeneous tumors. Radical gastrectomy and postoperative chemotherapy are the standard treatments. However, the safety and efficacy of neoadjuvant therapy (NAT) need to be confirmed by many trials before implementation, creating a bottleneck in development. Although clinical benefits of NAT have been observed, a series of problems remain to be solved. Before therapy, more contributing factors should be offered for choice in the intended population and ideal regimens. Enhanced computed tomography (CT) scanning is usually applied to evaluate effectiveness according to Response Evaluation Criteria in Solid Tumors (RECIST), yet CT scanning results sometimes differ from pathological responses. After NAT, the appropriate time for surgery is still empirically defined. Our review aims to discuss the abovementioned issues regarding NAT for GC, including indications, selection of regimens, lesion assessment and NAT-surgery interval time.

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Impact of interval timing to surgery on tumor response after neoadjuvant treatment for gastric cancer

Cited by 8 publications

References 34 publications

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Impact of the Interval between Neoadjuvant Chemotherapy and Gastrectomy on Pathological Response and Survival Outcomes for Patients with Locally Advanced Gastric Cancer: A Meta-analysis

Current status and future perspectives on neoadjuvant therapy in gastric cancer

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