Impact of the Interval Between Neoadjuvant Chemotherapy and Gastrectomy on Short- and Long-Term Outcomes for Patients with Advanced Gastric Cancer

Baušys, Augustinas; Ümarik, Toomas; Lukšta, Martynas; Reinsoo, Arvo; Račkauskas, Rokas; Anglickienė, Giedrė; Kryžauskas, Marius; Tõnismäe, Kristina; Senina, Veslava; Šeinin, Dmitrij; Baušys, Rimantas; Strupas, Kęstutis

doi:10.1245/s10434-020-09507-1

Cited by 11 publications

(6 citation statements)

References 31 publications

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“…Bausys et al. ( 12 ) reported that an interval of 30 days or less between the completion of neoadjuvant treatment and surgery significantly correlated with a higher MPR. Omarini et al.…”

Section: Discussionmentioning

confidence: 99%

“…There is a paucity of data available on optimal TTS after neoadjuvant immunochemotherapy in NSCLC, with more evidence relating to other cancers. Bausys et al (12) reported that an interval of 30 days or less between the completion of neoadjuvant treatment and surgery significantly correlated with a higher MPR. Omarini et al ( 13) and Sanford et al (14) concluded that a short interval between neoadjuvant chemotherapy (NAC) and surgery might be more effective for breast cancer patients.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the interval between neoadjuvant immunochemotherapy and surgery on surgical–pathological outcomes in non-small cell lung cancer

Chen

Deng

et al. 2022

Front. Oncol.

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IntroductionThe interval between neoadjuvant immunochemotherapy and surgery in patients with non-small cell lung cancer (NSCLC) has not been well characterized. This study investigated the association between the time-to-surgery (TTS) interval and surgical–pathological outcomes.MethodClinical data of patients who received neoadjuvant immun-ochemotherapy followed by surgery for NSCLC between January 2019 and September 2021 were collected. The patients were divided into three groups based on TTS interval: the early-surgery group (ESG), the standard-surgery group (SSG), and the delayed-surgery group (DSG). The primary outcomes were objective response rate (ORR), major pathological response (MPR), and pathological complete response (pCR). The secondary endpoint was surgical outcome.ResultsOf the 171 patients, 16 (9.4%) received surgery in ≤28 days, 49 (28.7%) received surgery within 29–42 days, and 106 (61.9%) received surgery in ≥43 days after neoadjuvant immunochemotherapy, with a median TTS of 46 days. The postoperative drainage of the ESG group (455.1 ml) was significantly less than that of the SSG group (680.7 ml) and the DSG group (846.5 ml; p = 0.037). However, the TTS interval did not influence the duration of the operation (P = 0.54), the extent of intraoperative bleeding (P = 0.60), or the length of postoperative hospital stay (P = 0.17). The ORR was observed in 69%, 51%, and 56% of patients in the ESG, the SSG, and the DSG, respectively (P = 0.46), and MPR occurred in 50%, 47%, and 58% (P = 0.38) of patients in the ESG, the SSG, and the DSG, respectively. Similarly, no statistically significant difference was found for pCR (ESG: 31%; SSG: 27%; DSG: 42%; P = 0.14).ConclusionThis retrospective study indicated that TTS exerts no significant effect on the feasibility and safety of surgery in the neoadjuvant immunochemotherapy setting of NSCLC. Analysis of the TTS interval revealed a tendency for delayed surgery to be associated with a pathological response in NSCLC, although this association was not statistically significant.

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“…Bausys et al. ( 12 ) reported that an interval of 30 days or less between the completion of neoadjuvant treatment and surgery significantly correlated with a higher MPR. Omarini et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of the interval between neoadjuvant immunochemotherapy and surgery on surgical–pathological outcomes in non-small cell lung cancer

Chen

Deng

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

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“…At the same time, the effects of chemotherapy drugs can increase the degree of oedema in the surrounding tissues, making surgery more difficult and risky (19). However, Augustinas Bausys' study found the opposite, that earlier surgery may result in better surgical outcomes for patients (11). In general, there is still a lack of sufficient researches and there is no evidence from large samples studies to provide guidance on the most appropriate interval time.…”

Section: Discussionmentioning

confidence: 99%

“…yinkui Wang performed detailed subgroups to obtain more precise time interval effects on patients (12). Both studies showed that an appropriate prolongation of TTS could lead to a survival benefit or a tumour regression benefit, but unlike the first two studies, Augustinas Bausys' study, which included 220 patients, obtained unfavourable results for prolonged TTS (11). This is the reason for conducting the present meta analysis.…”

Section: Discussionmentioning

confidence: 99%

Interval time between neoadjuvant chemotherapy and surgery in advanced gastric cancer doesn't affect outcome: A meta analysis

et al. 2023

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BackgroundThe efficacy of neoadjuvant chemotherapy for advanced gastric cancer is not yet firmly confirmed, but the exciting results demonstrated in several clinical studies have led neoadjuvant chemotherapy as the important treatment methods in guidelines. The 4–6 weeks interval time is currently the most commonly used in clinical treatment, but there are insufficient studies to support this time and the optimal interval has not yet been identified. The aim of this meta-analysis was to investigate the short-term life quality and long-term prognostic impact of the interval time between the end of neoadjuvant chemotherapy and surgery in patients with advanced gastric cancer.MethodsWe conducted a systematic literature search in PUBMED, Embase and Cochrane Liabrary for studies published or reported in English from January 2006 to May 2022. We summarised relevant studies for the time to surgery (TTS), included as retrospective studies and prospective studies. The primary study outcome was the rate of pathological complete response (pCR), and the secondary outcomes included R0 resection rate, incidence of serious postoperative complications, 3-year progression free survival time (PFS) rate and overall survival time (OS) rate. TTS were classified in three groups: 4–6 weeks, <4 weeks and >6 weeks. The ratio ratios (ORs) were calculated and forest plots and funnel plots were made to analysis by using fixed-effect and random-effect models in Review Manager 5.2.ResultsA total of five studies included 1,171 patients: 411 patients in shorter TTS group (<4 weeks), 507 patients in medium TTS group (4–6 weeks) and 253 patients in longer TTS groups (>6 weeks). And The results of our meta-analysis indicate that there are no significant difference between the three groups. The pCR, R0 resection rate, incidence of serious postoperative complications, 3-year PFS and OS were similar between three groups.ConclusionsAlthough there many studies exploring the suitable TTS in advanced gastric cancer, but we have not find the evidence to prove the TTS is the risk factor influencing the outcome.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022369009

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“…Currently, three studies have reported encouraging results that NACT combined with immunotherapy performed better in short-term outcomes than single NACT in LAGC treatment ( Supplementary Table 1 ), and six relevant clinical trials are going ( Supplementary Table 2 ). For further research, it is necessary to combine multi-omics techniques to predict the sensitive populations ( 46 – 48 ) and to discover clinical predictors associated with better pathologic responses ( 49 ), so that the therapeutic effect of LAGC will ultimately improve.…”

Section: Discussionmentioning

confidence: 99%

Combining neoadjuvant chemotherapy with PD-1/PD-L1 inhibitors for locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma: A systematic review and meta-analysis

et al. 2023

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BackgroundImmune checkpoint inhibitors (ICIs) have shown promising prospects in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma (GC/GEJC) immunotherapy, but their efficacy in neoadjuvant settings remains unclear. This study aimed to assess the efficacy and safety of integrating programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) inhibitors into neoadjuvant chemotherapy (NACT) of GC/GEJC treatment.MethodsPubMed, Cochrane Library, Embase, ClinicalTrials.gov, and main oncology conference databases were systematically searched up to 19 November 2022, and randomized controlled trials (RCTs) and cohort studies that evaluated the efficacy and safety of PD-1/PD-L1 inhibitors plus NACT were included. The main outcomes were pathological complete response (pCR), major pathological response (MPR), R0 resection rate, and treatment-related adverse events (TRAEs).ResultsA total of 753 patients from 20 prospective studies were included in this meta-analysis. The pooled pCR and MPR rates from studies reporting were 21.7% [95% confidence interval (CI), 18.1%–25.5%] and 44.0% (95% CI, 34.1%–53.8%), respectively. The pooled incidence rate of total TRAEs was 89.1% (95% CI, 82.7%–94.3%), and the incidence rate of grade 3 to 4 TRAEs was 34.4% (95% CI, 17.8%–66.5%). The pooled R0 resection rate was reported to be 98.9% (95% CI, 97.0%–99.9%). Subgroup analysis has not found significant differences in efficacy and safety among different PD-1/PD-L1 inhibitors. Moreover, the efficacy in patients with positive PD-L1 expression (combined positive score ≥1) was comparable with that in the entire study population [pCR, 22.5% vs. 21.2% (p > 0.05); MPR, 48.6% vs. 43.7% (p > 0.05)].ConclusionThis systematic review and meta-analysis found that PD-1/PD-L1 inhibitors combined with NACT for locally advanced GC/GEJC were well tolerated and may confer therapeutic advantages. The integration of ICIs into NACT has shown the potential for application in any PD-L1 expression population.

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Impact of the Interval Between Neoadjuvant Chemotherapy and Gastrectomy on Short- and Long-Term Outcomes for Patients with Advanced Gastric Cancer

Cited by 11 publications

References 31 publications

Impact of the interval between neoadjuvant immunochemotherapy and surgery on surgical–pathological outcomes in non-small cell lung cancer

Impact of the interval between neoadjuvant immunochemotherapy and surgery on surgical–pathological outcomes in non-small cell lung cancer

Interval time between neoadjuvant chemotherapy and surgery in advanced gastric cancer doesn't affect outcome: A meta analysis

Combining neoadjuvant chemotherapy with PD-1/PD-L1 inhibitors for locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma: A systematic review and meta-analysis

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