Optimal Timing for Postsurgical Adjuvant Therapy in Patients with Gastric Cancer: A Propensity Score Matching Study

Huang, Shih-Ming; Chen, Yen-Chao; Chen, Wan‐Yu; Yang, Lan-Yan; Tsan, Din-Li; Tsang, Ngan‐Ming; Yap, Wing-Keen; Tsai, Chien-Sheng; Leung, Wai-Man; Hong, Ji-Hong; Chang, Joseph Tung-Chieh; Yeh, Ta‐Sen; Wu, Tsung‐Han; Chen, Yi-Chan; Lin, Yun-Hsuan; Huang, Bing‐Shen

doi:10.7150/jca.27753

Cited by 13 publications

(11 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A logistic regression model was chose for calculating the propensity scores and the following covariates: tumor size, tumor location and tumor stage. The 1:1 matching process was peformed by using the nearest neighbor matching method, under a 0.2 caliper [28]. The optimal cutoff point of the ACCI was obtained through X-tile (Version 3.6.1, Yale University) [29, 30].…”

Section: Methodsmentioning

confidence: 99%

Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer

Huang

Xie

et al. 2019

BMC Surg

View full text Add to dashboard Cite

Introduction To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC). Method Data from patients with GC who underwent radical gastrectomy from January 2008 to December 2012 in Fujian Medical University Union Hospital were retrospectively analyzed. Patients were categorized into either high ACCI group or low ACCI group based on the effect of ACCI on long-term GC prognosis. 1:1 propensity score matching (PSM) was used to reduce confounding bias. To further analyze the impact of ACCI on the long-term prognosis of patients after radical gastrectomy, a nomogram was built based on the Cox proportional hazards regression model. Results A total of 1476 patients were included in the analysis. After PSM, there was no statistically significant differences in tumor location, tumor size and tumor stage between low ACCI group (429 cases) and high ACCI group (429 cases) (all P > 0.05). Before and after PSM, the incidence of postoperative complications in high ACCI group was significantly higher than that in low ACCI group ( P < 0.05). The 5-year overall survival rate (OS) in low ACCI group was significantly higher than that in high ACCI group. Multivariate analysis showed that ACCI was an independent risk factor for OS ( P < 0.05). The Harrell’s C-statistics (C-index) of TNMA, a prognostic evaluation system combining ACCI and TNM staging system, was significantly higher than that of TNM staging system in both the modeling and validation groups (all P < 0.05). Conclusions ACCI was an independent risk factor for the long-term prognosis of GC patients after radical gastrectomy that could effectively improve the predictive efficacy of the TNM staging system for GC. Electronic supplementary material The online version of this article (10.1186/s12893-019-0513-9) contains supplementary material, which is available to authorized users.

show abstract

Section: Methodsmentioning

confidence: 99%

Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer

Huang

Xie

et al. 2019

BMC Surg

View full text Add to dashboard Cite

show abstract

“…8,9 While many studies have examined the survival outcomes in POC patients with delayed TAC, the findings are inconsistent. [10][11][12] On the other hand, there have been a few studies of PEC outcomes with delayed TAC. 13 Moreover, little is known about the "flexion point" in the duration of chemotherapy; that is, the time frame in which optimal treatment efficacy can be achieved.…”

Section: Introductionmentioning

confidence: 99%

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

Liu¹,

Wang²,

Shan³

et al. 2021

CMAR

View full text Add to dashboard Cite

Background: The duration and the optimal time to adjuvant chemotherapy (TAC) in locally advanced gastric cancer (LAGC) have net not been sufficiently demonstrated. Sequential adjuvant chemotherapy (AC) after neoadjuvant chemotherapy plus gastrectomy is increasingly utilized, making the question more complicated. Patients and Methods: Data were collected from patients with LAGC who underwent 5-Fu-based doublet regimens as adjuvant treatment after gastrectomy in a single-center database. TAC and duration (cycles) were used to evaluate survival outcomes. Results: A total of 816 patients were included. Patients received over six cycles and TAC less than 42 days significantly correlated with better survival (log-rank P trend <0.001). The analysis of TAC and number cycles were separately applied in perioperative chemotherapy (PEC) and postoperative chemotherapy (POC) group using Cox regression. The number of cycles revealed a statistical significance improving OS rate both in POC (HR=0.904, 95% CI=0.836-0.977, P=0.011) and PEC (HR=0.887, 95% CI=0.798-0.986, P=0.026), while only in POC did the TAC show an increasing trend of risk with borderline significance (OS: HR=1.008, 95% CI=0.999-1.018, P=0.094; PFS: HR=1.009, 95% CI=1.000-1.018, P=0.055). A spline model demonstrates the less improvement in survival after cycles of chemotherapy reaching six. Conclusion: Our findings suggest that TAC is more likely to downregulate the survival benefit in POC rather than PEC, while overall survival is susceptible to cumulative cycles of chemotherapy in both groups. Furthermore, six cycles of chemotherapy tended to reach the maximum survival benefits. Prospective confirmation is required.

show abstract

“…Conversely, other reports showed no survival benefit for patients who received AC within 4 weeks of surgery ( 23 ). A study in Taiwan showed that starting AC within 8 weeks of a gastrectomy resulted in an improved 5-year recurrent-free survival rate, possibly contributing to an improved OS ( 24 ). Another study on AC using S-1 chemotherapy, from Japan, found that the timing of AC was not associated with OS ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Optimal time interval from surgery to adjuvant chemotherapy in gastric cancer

et al. 2020

View full text Add to dashboard Cite

The effect of adjuvant chemotherapy (AC) for resected gastric cancer is well established; however, delays in treatment and its impact on clinical outcomes have not yet been determined. The current study analyzed the survival rates based on time interval (TI) between surgery and AC administration to evaluate a potential association between the two variables. Patients diagnosed with stage II-III gastric adenocarcinoma between 2009 and 2016 at the Kyung Hee University Hospital were included. Patients' data including demographics, TNM stage, types of AC, and TI retrospectively collected from surgery to the start of AC. Patients were dichotomized based on the TI, which was predetermined at 3, 4, 5, 6, 7 or 8 weeks. Median disease-free survival (DFS) and overall survival (OS) were analyzed according to TI. In total, 172 patients were identified. The median follow-up duration was 40.8 (3-109) months. The median TI was 4.1 (2.1-9.8) weeks. DFS in patients with TI ≥4 weeks (n=106, 61.6%) was significantly lower compared with patients with TI <4 weeks (n=66, 38.4%), with a median DFS of TI < vs. ≥4 weeks of 8.1 vs. 6.0 years [hazard ratio (HR)=1.80, 95% confidence interval (CI): 1.067-3.045, P=0.0277]. OS was also significantly reduced in patients with TI ≥4 weeks, favoring TI <4 weeks [median OS of TI < vs. ≥4 weeks: Not reached (NR) vs. 7.0 years, HR=2.15, 95% CI: 1.173-3.939, P=0.0133]. Other predetermined TIs were not associated with survival outcomes. The current study demonstrated that AC within 4 weeks of surgery should be recommended for gastric cancer, and delays of >4 weeks may be detrimental to patients' survival.

show abstract

Optimal Timing for Postsurgical Adjuvant Therapy in Patients with Gastric Cancer: A Propensity Score Matching Study

Cited by 13 publications

References 33 publications

Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer

Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer

5-Fu-Based Doublet Regimen in Patients Receiving Perioperative or Postoperative Chemotherapy for Locally Advanced Gastric Cancer: When to Start and How Long Should the Regimen Last?

Optimal time interval from surgery to adjuvant chemotherapy in gastric cancer

Contact Info

Product

Resources

About