Highlights
- •Proximal and distal gastric cancers are biologically different but landmark trials have not segregated these.
- •The best approach for distal gastric cancer is debated.
- •There was no difference in OS and DFS between the perioperative and Upfront resection with adjuvant chemotherapy groups.
Abstract
Aim
This study aimed to assess the impact of treatment sequencing on long-term survival,
in distal gastric cancers (GCs) (stage IB/II/III).
Methods
This retrospective study included patients with distal GC undergoing D2 resection.
Outcomes were compared between group 1 (surgery with adjuvant chemotherapy) and group
2 (perioperative chemotherapy with surgery). 1:1 matching for baseline characteristics
(age, cT, and cN stage) was performed for outcome comparison.
Results
At a median follow-up of 47.5 months in the included 342 patients, the 5-year overall
survival (OS) was 61.1% and disease-free survival (DFS) was 50.5%. OS was comparable
in the unmatched (group 1, n = 118; group 2, n = 224) (HR 0.905, 95%CI 0.64–1.33,
P = 0.615) and matched groups (group 1, n = 97; group 2, n = 97) (HR 0.77, 95% CI
0.48–1.26, P = 0.3).
Conclusion
D2 resection followed by adjuvant chemotherapy provides similar long-term outcomes
as compared to perioperative chemotherapy approach for stage IB/II/III distal GCs.
Keywords
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References
- Current adjuvant treatment modalities for gastric cancer: from history to the future.World J Gastrointest Oncol. 2016 May 15; 8: 439-449
- Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.N Engl J Med. 2006 Jul 6; 355: 11-20
- Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.N Engl J Med. 2001 Sep 6; 345: 725-730
- Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine.N Engl J Med. 2007 Nov 1; 357: 1810-1820
- Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial.Lancet. 2019 May 11; 393: 1948-1957
- Comparison on clinicopathological features, treatments and prognosis between proximal gastric cancer and distal gastric cancer: a national cancer data base analysis.J Cancer. 2019; 10: 3145-3153
- Oesophageal adenocarcinoma and gastric cancer: should we mind the gap?.Nat Rev Cancer. 2016 Apr 26; 16: 305-318
- Upgrading the definition of early gastric cancer: better staging means more appropriate treatment.Cancer Biol Med. 2015 Dec; 12: 355-361
- Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial.Lancet. 2012 Jan 28; 379: 315-321
- D2 lymphadenectomy is not only safe but necessary in the era of neoadjuvant chemotherapy.World J Surg Oncol. 2013 Feb 2; 11: 31
- Classification of nodal stations in gastric cancer.Transl Gastroenterol Hepatol. 2017; 2: 2
- Perioperative epirubicin, oxaliplatin, and capecitabine chemotherapy in locally advanced gastric cancer: safety and feasibility in an interim survival analysis.J Gastric Cancer. 2017 Mar; 17: 21-32
- Epirubicin, oxaliplatin, and capectabine is just as "MAGIC"al as epirubicin, cisplatin, and fluorouracil perioperative chemotherapy for resectable locally advanced gastro-oesophageal cancer.J Cancer Res Therapeut. 2014 Oct-Dec; 10: 866-870
- Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations.Cancer. 1994 Jun 1; 73: 2680-2686
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009 Aug; 250: 187-196
- Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.Lancet. 1995 Mar 25; 345: 745-748
- Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial.Lancet Oncol. 2010 May; 11: 439-449
- Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial.J Clin Oncol. 2011 May 1; 29: 1715-1721
- Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis.BMC Cancer. 2016 Aug 12; 16: 631
- Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis.Sci Rep. 2015 Aug 5; 5: 12850
- Neoadjuvant chemotherapy for high-grade advanced gastric cancer.World J Surg. 1993 Mar-Apr; 17 (; discussion 61-2): 256-261
- [Long-term outcome of preoperative chemotherapy with 5'-deoxy-5-fluorouridine (5'-DFUR) for gastric cancer].Gan To Kagaku Ryoho. 2000 Sep; 27: 1521-1526
- A randomized consent design trial of neoadjuvant chemotherapy with tegafur plus uracil (UFT) for gastric cancer--a single institute study.Anticancer Res. 2004 May-Jun; 24: 1879-1887
- [A clinical study of paclitaxel combined with FOLFOX4 regimen as neoadjuvant chemotherapy for advanced gastric cancer].Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Sep; 13: 664-667
- Treatment of Borrmann type IV gastric cancer with a neoadjuvant chemotherapy combination of docetaxel, cisplatin and 5-fluorouracil/leucovorin.J Int Med Res. 2011; 39: 2096-2102
- Radical gastrectomy for gastric cancer at Tata memorial hospital.Indian J Cancer. 2017 Oct-Dec; 54: 605-608
- Neo-AEGIS (neoadjuvant trial in adenocarcinoma of the esophagus and esophago-gastric junction international study): preliminary results of phase III RCT of CROSS versus perioperative chemotherapy (modified MAGIC or FLOT protocol).. 2021; 39 (NCT01726452): 4004
Article Info
Publication History
Published online: October 26, 2021
Accepted:
October 22,
2021
Received in revised form:
October 6,
2021
Received:
February 13,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
