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

Abstract

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.

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

“…Some studies pointed out AC failed to provide superior survival improvement in R0 resected gastric and esophagogastric junction adenocarcinoma under PEC setting (13,14). However, our previous analyses did not completely favor their idea according to which AC is always a risk factor for LAGC patients' survival in patients with NAC treatment (15,16). Nevertheless, as several retrospective studies advocated the indiscrimination in survival between post-NAC (yp) and neutral stage (17,18), the strategies may be adapted to variation in yp stage in patients with initial LAGC diagnosis.…”

Application of Circulating Tumor Cells and Circulating Free DNA from Peripheral Blood in the Prognosis of Advanced Gastric Cancer

“…Spiral CT is a common method to evaluate the efficacy of chemotherapy for gastric cancer [28], and some studies suggested endoscopy, especially endoscopic ultrasound. A study by Wang et al [29] pointed out that there was no significant difference in the accuracy of abdominal CTenhanced scanning and ultrasound gastroscopy in the staging of gastric cancer after neoadjuvant chemotherapy.…”

Current status and future perspectives on neoadjuvant therapy in gastric cancer

“…The study revealed a better prognosis among patients with TTS within 22−35 d (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). The postoperative stay was significantly higher in the ≤21-day group, while no statistical significance was observed for the other parameters (P>0.05) ( 92 ).…”

“…It has been argued that delaying the operation too long might result in tumor repopulation and that dissection may be more difficult because of fibrosis. The question of whether delaying the operation until after NAT is beneficial is a topic of current debate in GC ( Table 3 ) ( 89 - 92 ). In general, the NACT-surgery interval time is commonly 4−6 weeks based upon empirical observations ( 93 ).…”