Neoadjuvant chemotherapy and adjuvant chemotherapy are similarly beneficial for five-year overall survival in locally advanced gastric cancer patients

Abstract

AbstractBackgroundDifferent types of neoadjuvant chemotherapy regimens have been compared for gastric cancer, mostly in terms of radiological downgrading or pathological tumor regression; however, no large-scale multicenter RCT study has conducted a head-to-head comparison of the overall survival rate between perioperative or neoadjuvant chemotherapy(NAC) and postoperative or adjuvant chemotherapy(AC). We explored whether the five-year overall survival rate was greater in patients who received perioperative chemotherapy plus surgery than in those who underwent surgery first and then had postoperative chemotherapy.MethodsAltogether, 77 patients with a clinical diagnosis of cTNM stage III were included. Five-year overall survival rates (OS) were compared between patients who underwent neoadjuvant chemotherapy plus surgery (NAC) and patients who underwent surgery first plus adjuvant chemotherapy (AC). Propensity score matching was applied to adjust for the disparity between the two groups. A Kaplan‒Meier plot was created for survival analysis, and the log rank method was used to compare the difference in OS.ResultsA total of 34 patients were in the NAC group, and 43 patients were in the AC group. There was no significant difference in age (median 64 vs. 66 years), cTNM staging, or extent of gastrectomy between the two groups (p<0.05).The median follow-up time was 58 months (range of 53-65 months). The five-year overall survival (OS) rates for the patients in the NAC group and AC group were 61.8% and 73.5%, respectively. There was no significant difference between the two groups in the five-year overall survival rates (p>0.05). There was no significant difference in the severity grading of postoperative complications between the two groups (p>0.05).ConclusionsThere was no significant difference in the five-year overall survival rate between the patients who underwent perioperative chemotherapy plus surgery and those who underwent surgery first plus postoperative chemotherapy. A well-controlled prospective study is necessary to reconfirm whether perioperative chemotherapy is superior to postoperative chemotherapy for gastric cancer patients.