Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2018; 24(2): 257-265
Published online Jan 14, 2018. doi: 10.3748/wjg.v24.i2.257
Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes
Yi Liu, Ke-Cheng Zhang, Xiao-Hui Huang, Hong-Qing Xi, Yun-He Gao, Wen-Quan Liang, Xin-Xin Wang, Lin Chen
Yi Liu, Ke-Cheng Zhang, Xiao-Hui Huang, Hong-Qing Xi, Yun-He Gao, Wen-Quan Liang, Xin-Xin Wang, Lin Chen, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Liu Y and Zhang KC designed the study and wrote the manuscript; Xi HQ and Huang XH contributed to the patient material; Liu Y collected the clinical data; Gao YH and Liang WQ contributed to data analysis and validation; all authors have reviewed and approved the final manuscript.
Supported by the Beijing Municipal Science and Technology Plan, No. D141100000414002; and the National Natural Science Foundation of China, No. 81272698, No. 81672319, and No. 81602507.
Institutional review board statement: The study was approved by the Chinese People’s Liberation Army General Hospital Research Ethics Committee.
Informed consent statement: Informed consent was not required because all the study participants had signed a consent form prior to neoadjuvant chemotherapy and the analysis used anonymous clinical data.
Conflict-of-interest statement: All the authors have no conflict of interest.
Data sharing statement: All data from which the conclusion could be drawn are presented in the manuscript. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lin Chen, MD, PhD, Professor, Chief, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlinbj301@163.com
Telephone: +86-10-66938128 Fax: +86-10-68181689
Received: November 20, 2017
Peer-review started: November 21, 2017
First decision: December 6, 2017
Revised: December 8, 2017
Accepted: December 13, 2017
Article in press: December 13, 2017
Published online: January 14, 2018
Processing time: 54 Days and 11.9 Hours
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; Timing of surgery; Neoadjuvant chemotherapy

Core tip: The impact of interval time between completion of neoadjuvant chemotherapy and surgery on pathological complete response (pCR) had been proved in colorectal cancer and esophageal cancer. However, no such research was found in gastric cancer. To evaluate whether the interval time impacts efficiency of neoadjuvant chemotherapy, 176 patients with gastric cancer were recruited. The interval time and clinical T stage were proved predictors of pCR. Post-neoadjuvant therapy pathological N stage and surgical procedure have a significant impact on the long-term survival. An interval time > 6 wk was associated with a higher odds of pCR.