Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2020; 26(8): 818-827
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.818
Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study
Yang Li, Fu-Hai Ma, Li-Yan Xue, Yan-Tao Tian
Yang Li, Fu-Hai Ma, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Li Y and Ma FH contributed equally to this work and they were involved in study concept, data acquisition, analysis, and interpretation, and production of tables, wrote the first draft, and revised it critically in light of comments from other authors; Tian YT and Xue LY were involved in study conception and design, data interpretation, manuscript revision, and discussion; all authors approved the final version submitted.
Supported by National Natural Science Foundation of China, No. 81772642; Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022.
Institutional review board statement: This study was approved by the institutional review board of the National Cancer Center of China.
Informed consent statement: The institutional review board waived informed consent due to the retrospective nature of this research.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Beijing 100021, China. tyt67@163.com
Received: January 13, 2020
Peer-review started: January 13, 2020
First decision: January 16, 2020
Revised: January 20, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: February 28, 2020
Processing time: 45 Days and 19 Hours
Abstract
BACKGROUND

The benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.

AIM

To evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.

METHODS

This retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach (cT3/4 and cN any) diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis (cTNM) staging system. We performed 1:1 propensity score matching (PSM) to reduce bias in patient selection. The histologic and prognostic effects of neoadjuvant chemotherapy were assessed. The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.

RESULTS

Of the 144 patients eligible for this study, 36 received neoadjuvant chemotherapy, and 108 received initial surgery after diagnosis. After adjustment by PSM, 36 pairs of patients were generated, and baseline characteristics, including age, sex, American Society of Anesthesiologists score, tumor location, and cTNM stage, were similar between the two groups. The R0 resection rates were 88.9% and 86.1% in the surgery-first and neoadjuvant chemotherapy groups after PSM, respectively (P = 1.000). The median follow-up period was 46.4 mo. The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0% and 65.0% (P = 0.235), respectively, before PSM and 50% and 64.7% (P = 0.192), respectively, after PSM. Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.

CONCLUSION

Neoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma. For resectable gastric signet-ring cell carcinoma, upfront surgery should be the primary therapy.

Keywords: Stomach neoplasms; Neoadjuvant therapy; Retrospective studies; Carcinoma; Signet ring cell; Outcome assessment

Core tip: Gastric cancer is the fifth most frequently diagnosed cancer and the second leading cause of cancer-related death globally. Despite a decrease in the overall incidence of gastric cancer in recent decades, the incidence of the subgroup of patients with signet-ring cell carcinoma is growing. This study provides evidence that neoadjuvant chemotherapy does not provide any survival advantage in gastric signet-ring cell carcinoma. For resectable gastric signet-ring cell carcinoma, surgery should be the primary therapy.