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. 2024 Sep 27;16(9):2878-2892.
doi: 10.4240/wjgs.v16.i9.2878.

Perioperative chemotherapy improves survival of patients with locally advanced diffuse gastric cancer

Ze-Feng Li  1 , Zheng Li  1 , Xiao-Jie Zhang  1 , Chong-Yuan Sun  1 , He Fei  1 , Chun-Xia Du  2 , Chun-Guang Guo  1 , Dong-Bing Zhao  1
Affiliations

Perioperative chemotherapy improves survival of patients with locally advanced diffuse gastric cancer

Ze-Feng Li et al. World J Gastrointest Surg. .

Abstract

Background: Whether patients with diffuse gastric cancer, which is insensitive to chemotherapy, can benefit from neoadjuvant or adjuvant chemotherapy has long been controversial.

Aim: To investigate whether perioperative chemotherapy can improve survival of patients with locally advanced diffuse gastric cancer.

Methods: A total of 2684 patients with locally advanced diffuse gastric cancer from 18 population-based cancer registries in the United States were analyzed.

Results: Compared with surgery alone, perioperative chemotherapy improved the prognosis of patients with locally advanced gastric cancer. Before stabilized inverse probability of treatment weighting (IPTW), the median overall survival (OS) times were 40.0 months and 13.0 months (P < 0.001), respectively. After IPTW, the median OS times were 33.0 months and 17.0 months (P < 0.001), respectively. Neoadjuvant chemotherapy did not improve the prognosis of patients with locally advanced gastric cancer compared with adjuvant chemotherapy after IPTW. After IPTW, the median OS times were 38.0 months in the neoadjuvant chemotherapy group and 42.0 months in the adjuvant chemotherapy group (P = 0.472).

Conclusion: Patients with diffuse gastric cancer can benefit from perioperative chemotherapy. There was no significant difference in survival between patients who received neoadjuvant chemotherapy and those who received adjuvant chemotherapy.

Keywords: Adjust chemotherapy; Gastric cancer; Neoadjuvant chemotherapy; Prognosis; Survival.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no disclosures or relevant conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for patients with diffuse gastric cancer receiving perioperative chemotherapy or surgery alone. A: The overall survival (OS) rates of patients who underwent perioperative chemotherapy or surgery alone; B: The cancer-specific survival (CSS) rates of patients who underwent perioperative chemotherapy or surgery alone; C: The OS rates of patients who underwent perioperative chemotherapy or surgery alone after inverse probability of treatment weighting (IPTW); D: The CSS rates of patients who underwent perioperative chemotherapy or surgery alone or surgery alone after IPTW. OS: Overall survival; CSS: Cancer-specific survival; IPTW: Inverse probability of treatment weighting.
Figure 2
Figure 2
Kaplan-Meier survival curves for patients with diffuse gastric cancer. A: Overall survival; B: Cancer-specific survival. N: Neoadjuvant chemotherapy, S: Surgery; A: Adjuvant chemotherapy.
Figure 3
Figure 3
Kaplan-Meier survival curves for patients with diffuse gastric cancer receiving neoadjuvant chemotherapy or adjuvant chemotherapy. A: The overall survival (OS) rates of patients who underwent perioperative chemotherapy; B: The cancer-specific survival (CSS) rates of patients who underwent perioperative chemotherapy; C: The OS rates of patients who underwent perioperative chemotherapy after inverse probability of treatment weighting (IPTW); D: The CSS rates of patients who underwent perioperative chemotherapy after IPTW. OS: Overall survival; CSS: Cancer-specific survival; IPTW: Inverse probability of treatment weighting.
Figure 4
Figure 4
Forest plot showing the subgroup analysis of the overall survival of patients receiving perioperative chemotherapy or surgery alone.
Figure 5
Figure 5
Forest plot showing the subgroup analysis of the overall survival of patients receiving neoadjuvant chemotherapy or adjuvant chemotherapy.
See this image and copyright information in PMC

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