Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2023; 15(1): 32-48
Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.32
Prognostic effect of excessive chemotherapy cycles for stage II and III gastric cancer patients after D2 + gastrectomy
Yi-Fan Li, Wen-Bing Zhang, Yu-Ye Gao
Yi-Fan Li, Department of General Surgery, Shanxi Province Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Wen-Bing Zhang, Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Yu-Ye Gao, Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing 00010, China
Author contributions: Li YF and Zhang WB conceptualized and designed the study, collected and analyzed the data, and wrote the manuscript; Li YF, Zhang WB and Gao YY revised the manuscript for important intellectual content; Gao YY participated in collection of the data; All authors approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Institutional Research Ethics Board of Ethics Committee of Shanxi Cancer Hospital (Taiyuan, China) (No. 2022JC23) and followed the Declaration of Helsinki.
Informed consent statement: All the authors report having no relevant conflicts of interest for this article.
Conflict-of-interest statement: No additional data are available.
Data sharing statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised according to the STROBE Statement - checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bing Zhang, MD, Chief Doctor, Surgeon, Endoscopy Center, Shanxi Province Cancer Hospital, No. 3 Xinghualing District, Staff New Village, Taiyuan 030013, Shanxi Province, China. lyf8028@126.com
Received: September 18, 2022
Peer-review started: September 18, 2022
First decision: October 20, 2022
Revised: November 4, 2022
Accepted: December 13, 2022
Article in press: December 13, 2022
Published online: January 27, 2023
Abstract
BACKGROUND

According to relevant investigation and analysis, there are few research studies on the effect of excessive chemotherapy cycles after D2 gastrectomy on the survival of patients with gastric cancer.

AIM

To determine whether excessive chemotherapy cycles provide extra survival benefits, reduce recurrence rate, and improve survival rate in patients with stage II or III gastric cancer.

METHODS

We analyzed and summarized 412 patients with stage II gastric cancer and 902 patients with stage III gastric cancer who received D2 gastrectomy plus adjuvant chemotherapy or neoadjuvant chemotherapy. Analysis and comparison at a ratio of 1:1 is aimed at reducing realistic baseline differences (n = 97 in each group of stage II, n = 242 in each group of stage III). Progression-free survival, overall survival and recurrence were the main outcome indicators.

RESULTS

When the propensity score was matched, the baseline features of stage II and III gastric cancer patients were similar between the two groups. After a series of investigations, Kaplan-Meier found that the progression-free survival and overall survival of stage II and III gastric cancer patients were consistent between the two groups. The local metastasis rate (P = 0.002), total recurrence rate (P < 0.001) and distant metastasis rate (P = 0.001) in the ≥ 9 cycle group of stage III gastric cancer were statistically lower than those in the < 9 cycle group. The interaction analysis by Cox proportional hazard regression model showed that intestinal type, proximal gastrectomy, and ≥ 6 cm maximum diameter of tumor had a higher risk of total mortality in the < 9 cycles group.

CONCLUSION

Overall, ≥ 9 chemotherapy cycles is not recommended for patients with stage II and stage III gastric cancer because it has an insignificant role in the prognosis of gastric cancer. However, for patients with stage III gastric cancer, ≥ 9 cycles of chemotherapy was shown to significantly decrease recurrence.

Keywords: Gastric cancer, Propensity score matching, Chemotherapy cycles, Overall survival, Progression-free survival, Recurrence

Core Tip: This retrospective study determined the survival benefit of excess chemotherapy cycles for gastric cancer after D2 gastrectomy. No difference in progression-free survival and overall survival was observed between patients receiving ≥ 9 or < 9 cycles of chemotherapy. Stage III gastric cancer patients receiving ≥ 9 cycles of chemotherapy had significantly lower overall recurrence, local-regional metastasis, and distant metastasis. The Cox proportional risk regression model was used in the exploration and analysis that intestinal type, proximal gastrectomy, and ≥ 6 cm maximum tumor diameter had a higher risk of total mortality in the < 9 cycles of chemotherapy group.