Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes

Liu, Yi; Zhang, Kecheng; Huang, Xiaohui; Xi, Hongqing; Gao, Yunhe; Liang, Wenying; Wang, Xinxin; Chen, Lin

doi:10.3748/wjg.v24.i2.257

Cited by 36 publications

(32 citation statements)

References 31 publications

(33 reference statements)

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“…Clinical practice guidelines on the maximum TTS and the results from numerous studies are conflicting. While some studies found no correlation between survival and the TTS in various solid tumors 4 , 5 , other studies showed that surgery should be performed within 3-8 weeks after NACT 6 - 8 . Moreover, in ovarian cancer, few large randomized clinical trials on NACT have thoroughly addressed the TTS, and many do not even specify a recommended time interval.…”

Section: Introductionmentioning

confidence: 98%

Impact of the Time Interval from Neoadjuvant Chemotherapy to Surgery in Primary Ovarian, Tubal, and Peritoneal Cancer Patients

Chen¹,

Chen²,

Xu³

et al. 2018

J. Cancer

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Neoadjuvant chemotherapy (NACT) plays an important role in ovarian cancer. The appropriate time interval from the completion of NACT to interval debulking surgery (TTS) in ovarian cancer is still unknown. The aim of this retrospective study was to evaluate the effect of the time interval between the end of NACT and surgery (TTS ≤ 4 weeks vs TTS > 4 weeks) on the survival outcomes among patients with advanced-stage ovarian, tubal, and peritoneal cancers. 152 patients with stage III or IV ovarian, tubal, and peritoneal cancers were included in this retrospective cohort study: 115 in the TTS ≤4 weeks and 37 in the TTS >4 weeks groups. The Kaplan-Meier analysis showed that the progression-free survival in the TTS ≤4 weeks group was longer than that in the TTS >4 weeks group (26 vs 14 months, P=0.04). However, the overall survival was not different between the two groups (66 vs 36 months, P=0.105). The multivariate analysis presented that delay in surgery after NACT (TTS >4 weeks) was associated with a shorter progression-free (P=0.002) but not overall survival (P=0.231). Our findings demonstrated no relationship between the NACT to surgery interval and OS, while a detrimental effect of TTS >4 weeks on PFS was observed.

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Section: Introductionmentioning

confidence: 98%

Impact of the Time Interval from Neoadjuvant Chemotherapy to Surgery in Primary Ovarian, Tubal, and Peritoneal Cancer Patients

Chen¹,

Chen²,

Xu³

et al. 2018

J. Cancer

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“…Studies of other gastrointestinal neoplasms such as esophageal and rectal cancer found a better survival benefit or pathological response rate in patients with longer time to surgery (TTS) (6)(7)(8)(9). Comparable studies in GC patients have shown no effect on OS or DFS, while the improvement in pathologic complete response (pCR) is significantly higher in patients with longer TTS (10,11). However, the conclusion regarding pathological improvement was based on a retrospective study and a relatively small sample size with only 17 of 176 patients in the >6 weeks group.…”

Section: Introductionmentioning

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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“…Some studies have indicated that extending TTS might increase the proportion of patients with a pathologic complete response (pCR) among rectal cancer patients receiving neoadjuvant chemoradiotherapy (nCRT) 8,9 . In addition, for esophageal cancer patients with nCRT and gastric cancer patients with NAC, studies revealed that patients with a longer TTS had significantly higher pCR rates and better prognosis 10‐12 . However, other studies have not shown the relationship between longer TTS and higher pCR rates and have revealed that longer TTS was associated with worse overall survival 13,14 .…”

Section: Introductionmentioning

confidence: 99%

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

et al. 2020

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Background Neoadjuvant chemotherapy (NAC) has been widely performed in the treatment of colorectal cancer liver metastasis (CRLM) patients, but the optimal timing of surgery after NAC is unclear. The aim of this study was to investigate the optimal timing of surgery. Methods From December 2010 to May 2018, 101 consecutive patients who received NAC followed by liver resection for CRLM were included in this study. The main outcome parameters were pathological response, progression‐free survival (PFS), and overall survival (OS). The effect of time to surgery (TTS) on patient outcomes, defined as a high TTS and a low TTS according to an X‐tile analysis, was investigated. To adjust for potential selection bias, propensity score matching at 1:2 was performed with two high TTS patients matched to one low TTS patient. Kaplan‐Meier curves, logistic regression analyses, and Cox regression models were used for the data analysis. Results The optimal cut‐off value for the TTS was 5 weeks by X‐tile analysis. The patients in this study were divided into low (≤5 weeks, n = 27) and high (>5 weeks, n = 74) TTS groups. Patients with a high TTS were more likely to have an unfavorable pathological response (75.7% vs 48.1%, P = .008). In multivariate analysis, a low TTS significantly predicted a better pathological response (OR = 3.397, 95% CI: 1.116‐10.344, P = .031). Compared to patients with a high TTS, patients with a low TTS had significantly better PFS (P < .001, mPFS: 16 months vs 7 months) and better OS (P = .037, mOS: not reached vs 36 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 2.041, 95% CI: 1.152‐3.616, P = .014) but not OS. After propensity matching, the patients with a low TTS had significantly better PFS (P < .001, mPFS: 18.2 months vs 10 months) and an equivalent OS (P = .115, mOS: not reached vs 41 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 3.031, 95% CI: 1.494‐6.149, P = .002) but not OS. Conclusion The longer TTS after the completion of NAC may be disadvantageous for a favorable pathological response and long‐term PFS. These results should be validated prospectively in a randomized trial.

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Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes

Cited by 36 publications

References 31 publications

Impact of the Time Interval from Neoadjuvant Chemotherapy to Surgery in Primary Ovarian, Tubal, and Peritoneal Cancer Patients

Impact of the Time Interval from Neoadjuvant Chemotherapy to Surgery in Primary Ovarian, Tubal, and Peritoneal Cancer Patients

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

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

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