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Neoadjuvant Chemotherapy Does Not Improve Survival in cT2N0M0 Gastric Adenocarcinoma Patients: A Multicenter Propensity Score Analysis

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Title: Neoadjuvant Chemotherapy Does Not Improve Survival in cT2N0M0 Gastric Adenocarcinoma Patients: A Multicenter Propensity Score Analysis
Authors: Francesco Abboretti, Céline Lambert, Markus Schäfer, Bruno Pereira, Bertrand Le Roy, Diane Mège, Guillaume Piessen, Johan Gagnière, Caroline Gronnier, Styliani Mantziari
Contributors: ADENOKGAST Study Group, AFC-French Association of Surgery
Source: Ann Surg Oncol
Annals of surgical oncology, vol. 31, no. 8, pp. 5273-5282
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Male, Humans, Stomach Neoplasms/pathology, Stomach Neoplasms/mortality, Stomach Neoplasms/drug therapy, Stomach Neoplasms/surgery, Female, Neoadjuvant Therapy/mortality, Adenocarcinoma/mortality, Adenocarcinoma/pathology, Adenocarcinoma/drug therapy, Adenocarcinoma/surgery, Adenocarcinoma/therapy, Middle Aged, Retrospective Studies, Aged, Survival Rate, Follow-Up Studies, Propensity Score, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Chemotherapy, Adjuvant/mortality, Prognosis, Neoplasm Staging, Gastrectomy/mortality, Neoadjuvant therapy, Propensity score, Stomach neoplasms, Survival analysis, Gastrointestinal Oncology, Adenocarcinoma, Neoadjuvant Therapy, 03 medical and health sciences, 0302 clinical medicine, Stomach Neoplasms, Chemotherapy, Adjuvant, Gastrectomy, Antineoplastic Combined Chemotherapy Protocols
Description: Background According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences. Objective The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients. Methods A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups. Results Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW. Conclusions Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-024-15418-2
Access URL: https://pubmed.ncbi.nlm.nih.gov/38762640
https://serval.unil.ch/notice/serval:BIB_B783B53575E1
http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_B783B53575E10
https://serval.unil.ch/resource/serval:BIB_B783B53575E1.P001/REF.pdf
Rights: CC BY
Accession Number: edsair.doi.dedup.....25cc159e78cd8cd7983b2dae29bf7a2a
Database: OpenAIRE
Description
Abstract:Background According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences. Objective The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients. Methods A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups. Results Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW. Conclusions Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
ISSN:15344681
10689265
DOI:10.1245/s10434-024-15418-2