Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Dec 27, 2013; 5(12): 321-328
Published online Dec 27, 2013. doi: 10.4240/wjgs.v5.i12.321
Timing of chemotherapy and survival in patients with resectable gastric adenocarcinoma
Amanda K Arrington, Rebecca Nelson, Supriya S Patel, Carrie Luu, Michelle Ko, Julio Garcia-Aguilar, Joseph Kim
Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Rebecca Nelson, Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Supriya S Patel, Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
Carrie Luu, Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA 90509, United States
Julio Garcia-Aguilar, Division of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, United States
Author contributions: Arrington AK, Nelson R and Kim J designed the research; Arrington AK, Nelson R and Kim J performed the research; Nelson R contributed new analytic tools; Arrington AK, Nelson R, Kim J analyzed data; Arrington AK, Nelson R, Patel SS, Luu C, Ko M, Garcia-Aguilar J and Kim J wrote the paper.
Correspondence to: Joseph Kim, MD, Associate Professor of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, United States.
Telephone: +1- 626-471-7100 Fax: +1- 626-3018865
Received: July 22, 2013
Revised: November 19, 2013
Accepted: December 12, 2013
Published online: December 27, 2013

AIM: To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups.

METHODS: Patients with surgically resected gastric adenocarcinoma from 1988 to 2006 were identified from the Los Angeles County Cancer Surveillance Program. To evaluate the population most likely to receive and/or benefit from adjunct chemotherapy, inclusion criteria consisted of Stage II or III gastric cancer patients > 18 years of age who underwent curative-intent surgical resection. Patients were categorized into three groups according to the receipt of chemotherapy: (1) no chemotherapy; (2) preoperative chemotherapy; or (3) postoperative chemotherapy. Clinical and pathologic characteristics were compared across the different treatment arms.

RESULTS: Of 1518 patients with surgically resected gastric cancer, 327 (21.5%) received perioperative chemotherapy. The majority of these 327 patients were male (68%) with a mean age of 61.5 years; and they were significantly younger than non-chemotherapy patients (mean age, 70.7; P < 0.001). Most patients had tumors frequently located in the distal stomach (34.5%). Preoperative chemotherapy was administered to 11.3% of patients (n = 37) and postoperative therapy to 88.7% of patients (n = 290). An overall survival benefit according to timing of chemotherapy was not observed on univariate or multivariate analysis. Similar results were observed with stage-specific survival analyses (5-year overall survival: Stage II, 25% vs 30%, respectively; Stage III, 14% vs 11%, respectively). Therefore, our results do not identify a survival advantage for specific timing of chemotherapy in locally advanced gastric cancer.

CONCLUSION: This study supports the implementation of a randomized trial comparing the timing of perioperative therapy in patients with locally advanced gastric cancer.

Keywords: Chemotherapy, Gastric cancer, Adjunct therapy, Postoperative therapy, Preoperative therapy, Timing

Core tip: Curative intent surgical resection offers the best survival potential in conjunction with chemotherapy for patients with gastric cancer. Few studies have evaluated the optimal timing of chemotherapy. This study shows that in the setting of resectable gastric cancer, there is no survival advantage based on the timing of chemotherapy.