Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan 14;24(2):257-265.
doi: 10.3748/wjg.v24.i2.257.

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

Yi Liu  1 , Ke-Cheng Zhang  1 , Xiao-Hui Huang  1 , Hong-Qing Xi  1 , Yun-He Gao  1 , Wen-Quan Liang  1 , Xin-Xin Wang  1 , Lin Chen  2
Affiliations

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

Yi Liu et al. World J Gastroenterol. .

Abstract

Aim: To evaluate whether the neoadjuvant chemotherapy (NACT)-surgery interval time significantly impacts the pathological complete response (pCR) rate and long-term survival.

Methods: One hundred and seventy-six patients with gastric cancer undergoing NACT and a planned gastrectomy at the Chinese PLA General Hospital were selected from January 2011 to January 2017. Univariate and multivariable analyses were used to investigate the impact of NACT-surgery interval time (< 4 wk, 4-6 wk, and > 6 wk) on pCR rate and overall survival (OS).

Results: The NACT-surgery interval time and clinician T stage were independent predictors of pCR. The interval time > 6 wk was associated with a 74% higher odds of pCR as compared with an interval time of 4-6 wk (P = 0.044), while the odds ratio (OR) of clinical T3vs clinical T4 stage for pCR was 2.90 (95%CI: 1.04-8.01, P = 0.041). In Cox regression analysis of long-term survival, post-neoadjuvant therapy pathological N (ypN) stage significantly impacted OS (N0vs N3: HR = 0.16, 95%CI: 0.37-0.70, P = 0.015; N1vs N3: HR = 0.14, 95%CI: 0.02-0.81, P = 0.029) and disease-free survival (DFS) (N0vs N3: HR = 0.11, 95%CI: 0.24-0.52, P = 0.005; N1vs N3: HR = 0.17, 95%CI: 0.02-0.71, P = 0.020). The surgical procedure also had a positive impact on OS and DFS. The hazard ratio of distal gastrectomy vs total gastrectomy was 0.12 (95%CI: 0.33-0.42, P = 0.001) for OS, and 0.13 (95%CI: 0.36-0.44, P = 0.001) for DFS.

Conclusion: The NACT-surgery interval time is associated with pCR but has no impact on survival, and an interval time > 6 wk has a relatively high odds of pCR.

Keywords: Gastric cancer; Neoadjuvant chemotherapy; Timing of surgery.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All the authors have no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patient inclusion.
Figure 2
Figure 2
Overall survival and disease-free survival curves of the three groups. OS: Overall survival; DFS: Disease-free survival.
Figure 3
Figure 3
Cumulative frequency of pathological complete remission by neoadjuvant chemotherapy to surgery interval time. NACT: Neoadjuvant chemotherapy.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Patel SH, Kooby DA. Gastric adenocarcinoma surgery and adjuvant therapy. Surg Clin North Am. 2011;91:1039–1077. - PubMed
    1. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, Scarffe JH, Lofts FJ, Falk SJ, Iveson TJ, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. - PubMed
    1. Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, Ducourtieux M, Bedenne L, Fabre JM, Saint-Aubert B, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29:1715–1721. - PubMed
    1. Xiong BH, Cheng Y, Ma L, Zhang CQ. An updated meta-analysis of randomized controlled trial assessing the effect of neoadjuvant chemotherapy in advanced gastric cancer. Cancer Invest. 2014;32:272–284. - PubMed
    1. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. Br J Surg. 2012;99:918–928. - PubMed

MeSH terms

Substances