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. 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.

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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

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