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©The Author(s) 2024.
World J Gastrointest Surg. Sep 27, 2024; 16(9): 2878-2892
Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2878
Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2878
Table 1 Baseline clinicopathologic characteristics of patients with diffuse gastric adenocarcinoma with or without perioperative chemotherapy before and after inverse probability of treatment weighting, n (%)
| Characteristic | Before IPTW | After IPTW | ||||
| Surgery alone | Perioperative chemotherapy (n = 1448) | P value | Surgery alone (n = 2660.3) | Perioperative chemotherapy (n = 2721.4) | P value | |
| Age | < 0.001 | 0.883 | ||||
| ≤ 45 | 59 (4.8) | 241 (16.6) | 316.8 (11.9) | 301.3 (11.1) | ||
| 45-70 | 449 (36.3) | 855 (59.0) | 1268.4 (47.7) | 1312.5 (48.2) | ||
| ≥ 70 | 728 (58.9) | 352 (24.3) | 1075.0 (40.4) | 1107.6 (40.7) | ||
| Sex | 0.111 | 0.191 | ||||
| Male | 634 (51.3) | 697 (48.1) | 1385.5 (52.1) | 1328.0 (48.8) | ||
| Female | 602 (48.7) | 751 (51.9) | 1274.8 (47.9) | 1393.4 (51.2) | ||
| Race | 0.041 | 0.456 | ||||
| White | 828 (67.0) | 915 (63.2) | 1742.1 (65.5) | 1678.2 (61.7) | ||
| Black | 140 (11.3) | 152 (10.5) | 321.1 (12.1) | 335.6 (12.3) | ||
| Asian | 252 (20.4) | 353 (24.4) | 552.6 (20.8) | 654.7 (24.1) | ||
| Other | 16 (1.3) | 28 (1.9) | 44.4 (1.7) | 52.9 (1.9) | ||
| Diagnosis period | < 0.001 | 0.799 | ||||
| 2004-2010 | 693 (56.1) | 275 (19.0) | 980.3 (36.8) | 1019.9 (37.5) | ||
| 2010-2020 | 543 (43.9) | 1173 (81.0) | 1680.0 (63.2) | 1701.6 (62.5) | ||
| Tumor location | 0.001 | 0.994 | ||||
| Upper one-third | 131 (10.6) | 188 (13.0) | 313.3 (11.8) | 315.8 (11.6) | ||
| Middle one-third | 351 (28.4) | 481 (33.2) | 809.9 (30.4) | 838.2 (30.8) | ||
| Lower one-third | 447 (36.2) | 428 (29.6) | 889.2 (33.4) | 916.4 (33.7) | ||
| Over lapping | 156 (12.6) | 196 (13.5) | 351.3 (13.2) | 366.4 (13.5) | ||
| Unknown | 151 (12.2) | 155 (10.7) | 296.5 (11.1) | 284.6 (10.5) | ||
| Histology type | 0.117 | 0.069 | ||||
| Diffuse | 349 (28.2) | 410 (28.3) | 835.0 (31.4) | 716.8 (26.3) | ||
| Signet-ring cell carcinoma | 852 (68.9) | 1014 (70.0) | 1767.7 (66.4) | 1950.4 (71.7) | ||
| Linitis plastica | 35 (2.8) | 24 (1.7) | 57.6 (2.2) | 54.3 (2.0) | ||
| Grade | 0.307 | 0.576 | ||||
| Well/Moderately differentiated | 34 (2.8) | 30 (2.1) | 61.2 (2.3) | 53.6 (2.0) | ||
| Poorly/undifferentiated | 1202 (97.2) | 1418 (97.9) | 2599.1 (97.7) | 2667.8 (98.0) | ||
| T stage | < 0.001 | 0.921 | ||||
| 1 | 76 (6.1) | 86 (5.9) | 184.4 (6.9) | 172.7 (6.3) | ||
| 2 | 73 (5.9) | 160 (11.0) | 206.9 (7.8) | 231.2 (8.5) | ||
| 3 | 562 (45.5) | 678 (46.8) | 1208.2 (45.4) | 1220.7 (44.9) | ||
| 4 | 525 (42.5) | 524 (36.2) | 1060.7 (39.9) | 1096.8 (40.3) | ||
| N stage | 0.084 | 0.821 | ||||
| 0 | 333 (26.9) | 388 (26.8) | 741.1 (27.9) | 706.2 (26.0) | ||
| 1 | 261 (21.1) | 362 (25.0) | 558.6 (21.0) | 566.3 (20.8) | ||
| 2 | 280 (22.7) | 292 (20.2) | 575.2 (21.6) | 619.6 (22.8) | ||
| 3 | 362 (29.3) | 406 (28.0) | 785.4 (29.5) | 829.4 (30.5) | ||
| D2 surgery | < 0.001 | 0.969 | ||||
| No | 914 (73.9) | 667 (46.2) | 1573.7 (59.2) | 1607.3 (59.1) | ||
| Yes | 322 (26.1) | 781 (53.8) | 1086.5 (40.8) | 1114.1 (40.9) | ||
| OS (95%CI) | ||||||
| 1-year | 51.6 (48.9, 54.5) | 84.6 (82.6, 86.5) | 57.2 (53.9, 60.8) | 79.2 (76.0, 82.5) | ||
| 3-year | 27.0 (24.5, 29.6) | 52.3 (49.5, 55.2) | 33.9 (30.4, 37.9) | 47.3 (43.8, 51.1) | ||
| 5-year | 19.6 (17.4, 22.1) | 40.0 (37.1, 43.0) | 26.4 (22.9, 30.4) | 35.0 (31.5, 38.9) | ||
| Median OS (95%CI), month | 13.0 (12.0, 15.0) | 40.0 (36.0, 44.0) | 17.0 (15.0, 20.0) | 33.0 (30.0, 38.0) | ||
| CSS (95%CI) | ||||||
| 1-year | 57.9 (55.1, 60.9) | 86.3 (84.4, 88.1) | 62.5 (59.1, 66.1) | 81.3 (78.1, 84.5) | ||
| 3-year | 34.9 (32.0, 38.0) | 56.3 (53.5, 59.3) | 41.3 (37.4, 45.5) | 51.5 (47.8, 55.4) | ||
| 5-year | 28.0 (25.2, 31.0) | 45.3 (42.3, 48.5) | 34.3 (30.3, 38.7) | 41.2 (37.5, 45.3) | ||
| Median CSS (95%CI), month | 18.0 (16.0, 21.0) | 47.0 (42.0, 54.0) | 24.0 (20.0, 30.0) | 39.0 (33.0, 45.0) | ||
Table 2 Baseline clinicopathologic characteristics of patients with diffuse gastric adenocarcinoma receiving neoadjuvant chemotherapy or adjuvant chemotherapy before and after inverse probability of treatment weighting, n (%)
| Characteristic | Before IPTW | After IPTW | ||||
| Adjuvant chemotherapy (n = 576) | Neoadjuvant chemotherapy (n = 872) | P value | Adjuvant chemotherapy (n = 1458.4) | Neoadjuvant chemotherapy (n = 1445.0) | P value | |
| Age | 0.026 | 0.916 | ||||
| ≤ 45 | 87 (15.1) | 154 (17.7) | 232.9 (16.0) | 243.1 (16.8) | ||
| 45-70 | 328 (56.9) | 527 (60.4) | 882.9 (60.5) | 861.9 (59.7) | ||
| ≥ 70 | 161 (28.0) | 191 (21.9) | 342.6 (23.5) | 339.9 (23.5) | ||
| Sex | 0.347 | 0.823 | ||||
| Male | 268 (46.5) | 429 (49.2) | 694.4 (47.6) | 697.4 (48.3) | ||
| Female | 308 (53.5) | 443 (50.8) | 764.0 (52.4) | 747.6 (51.7) | ||
| Race | 0.170 | 0.314 | ||||
| White | 347 (60.2) | 568 (65.1) | 897.2 (61.5) | 938.7 (65.0) | ||
| Black | 66 (11.5) | 86 (9.9) | 144.3 (9.9) | 140.4 (9.7) | ||
| Asian | 154 (26.7) | 199 (22.8) | 394.7 (27.1) | 332.9 (23.0) | ||
| Other | 9 (1.6) | 19 (2.2) | 22.2 (1.5) | 32.9 (2.3) | ||
| Diagnosis period | < 0.001 | 0.942 | ||||
| 2004-2010 | 151 (26.2) | 124 (14.2) | 270.0 (18.5) | 269.8 (18.7) | ||
| 2010-2020 | 425 (73.8) | 748 (85.8) | 1188.4 (81.5) | 1175.1 (81.3) | ||
| Tumor location | < 0.001 | 0.988 | ||||
| Upper one-third | 45 (7.8) | 143 (16.4) | 202.5 (13.9) | 189.4 (13.1) | ||
| Middle one-third | 198 (34.4) | 283 (32.5) | 500.2 (34.3) | 488.8 (33.8) | ||
| Lower one-third | 198 (34.4) | 230 (26.4) | 417.2 (28.6) | 418.5 (29.0) | ||
| Overlapping | 72 (12.5) | 124 (14.2) | 181.0 (12.4) | 191.2 (13.2) | ||
| Unknown | 63 (10.9) | 92 (10.6) | 157.5 (10.8) | 157.0 (10.9) | ||
| Histology type | 0.753 | 0.999 | ||||
| Diffuse | 159 (27.6) | 251 (28.8) | 400.3 (27.4) | 397.9 (27.5) | ||
| Signet-ring cell carcinoma | 406 (70.5) | 608 (69.7) | 1034.4 (70.9) | 1023.9 (70.9) | ||
| Linitis plastica | 11 (1.9) | 13 (1.5) | 23.7 (1.6) | 23.2 (1.6) | ||
| Grade | 0.179 | 0.056 | ||||
| Well/moderately differentiated | 16 (2.8) | 14 (1.6) | 48.1 (3.3) | 22.2 (1.5) | ||
| Poorly/undifferentiated | 560 (97.2) | 858 (98.4) | 1410.3 (96.7)) | 1422.8 (98.5) | ||
| T stage | < 0.001 | 0.996 | ||||
| 1 | 40 (6.9) | 46 (5.3) | 91.7 (6.3) | 87.8 (6.1) | ||
| 2 | 60 (10.4) | 100 (11.5) | 155.9 (10.7)) | 158.6 (11.0) | ||
| 3 | 223 (38.7) | 455 (52.2) | 683.8 (46.9) | 671.7 (46.5) | ||
| 4 | 253 (43.9) | 271 (31.1) | 527.1 (36.1) | 526.8 (36.5) | ||
| N stage | < 0.001 | 0.963 | ||||
| 0 | 126 (21.9) | 262 (30.0) | 418.2 (28.7) | 395.0 (27.3) | ||
| 1 | 121 (21.0) | 241 (27.6) | 351.0 (24.1) | 356.3 (24.7) | ||
| 2 | 132 (22.9) | 160 (18.3) | 283.7 (19.5) | 282.6 (19.6) | ||
| 3 | 197 (34.2) | 209 (24.0) | 405.6 (27.8) | 411.1 (28.4) | ||
| D2 surgery | < 0.001 | 0.996 | ||||
| No | 310 (53.8) | 357 (40.9) | 672.7 (46.1) | 666.7 (46.1) | ||
| Yes | 266 (46.2) | 515 (59.1) | 785.7 (53.9) | 778.3 (53.9) | ||
| OS (95%CI) | ||||||
| 1-year | 79.4 (76.1, 82.9) | 88.0 (85.8, 90.3) | 83.5 (80.5, 86.6) | 86.2 (83.6, 88.9) | ||
| 3-year | 48.7 (44.5, 53.4) | 54.6 (51.0, 58.5) | 53.0 (48.3, 58.1) | 51.6 (47.8, 55.6) | ||
| 5-year | 37.9 (33.7. 42.6) | 41.2 (37.4, 45.4) | 42.7 (37.9, 48.1) | 37.8 (34.0, 42.2) | ||
| Median OS (95%CI), month | 34.0 (31.0, 42.0) | 42.0 (38.0, 48.0) | 42.0 (35.0, 53.0) | 38.0 (35.0, 44.0) | ||
| CSS (95%CI) | ||||||
| 1-year | 81.2 (78.0, 84.6) | 89.6 (87.5, 91.8) | 85.0 (82.1, 88.0) | 87.8 (85.3, 90.4) | ||
| 3-year | 52.4 (48.1, 57.1) | 59.0 (55.3, 62.9) | 56.5 (51.8, 61.7) | 56.0 (52.1, 60.1) | ||
| 5-year | 43.3 (38.8, 48.2) | 46.4 (42.4, 50.9) | 47.8 (42.8, 53.3) | 43.1 (39.0, 47.4) | ||
| Median CSS (95%CI), month | 42.0 (33.0, 53.0) | 52.0 (43.0, 64.0) | 53.0 (42.0, 80.0) | 45.0 (39.0, 54.0) | ||
Table 3 Univariable and multivariable Cox Regression analyses of factors associated with overall survival of patients with diffuse gastric adenocarcinoma
| Characteristic | Univariable analysis HR (95%CI) | P value | Multivariable analysis HR (95%CI) | P value |
| Age | ||||
| ≤ 45 | 1 (Reference) | 1 (Reference) | ||
| 45-70 | 1.435 (1.201-1.716) | < 0.001 | 1.229 (1.026-1.471) | 0.025 |
| ≥ 70 | 2.375 (1.989-2.837) | < 0.001 | 1.791 (1.490-2.153) | < 0.001 |
| Sex | ||||
| Male | 1 (Reference) | |||
| Female | 0.973 (0.886-1.068) | 0.566 | ||
| Race | ||||
| White | 1 (Reference) | 1 (Reference) | ||
| Black | 0.919 (0.792-1.067) | 0.269 | 1.027 (0.883-1.194) | 0.733 |
| Asian | 0.741 (0.657-0.835) | < 0.001 | 0.789 (0.698-0.891) | < 0.001 |
| Other | 0.867 (0.592-1.270) | 0.464 | 1.394 (0.947-2.054) | 0.093 |
| Diagnosis period | ||||
| 2004-2010 | 1 (Reference) | 1 (Reference) | ||
| 2010-2020 | 0.692 (0.629-0.761) | < 0.001 | 0.888 (0.799-0.986) | 0.026 |
| Tumor location | ||||
| Upper one-third | 1 (Reference) | 1 (Reference) | ||
| Middle one-third | 0.813 (0.693-0.955) | 0.012 | 0.838 (0.711-0.987) | 0.034 |
| Lower one-third | 0.996 (0.851-1.165) | 0.956 | 0.954 (0.813-1.120) | 0.568 |
| Overlapping | 1.317 (1.096-1.581) | 0.003 | 1.099 (0.911-1.325) | 0.324 |
| Unknown | 1.436 (1.193-1.729) | < 0.001 | 1.268 (1.049-1.532) | 0.014 |
| Histology type | ||||
| Diffuse | 1 (Reference) | 1 (Reference) | ||
| Signet-ring cell carcinoma | 0.948 (0.853-1.054) | 0.322 | 0.995 (0.894-1.108) | 0.929 |
| Linitis plastica | 1.821 (1.367-2.424) | < 0.001 | 1.514 (1.130-2.029) | 0.006 |
| Grade | ||||
| Well/moderately differentiated | 1 (Reference) | |||
| Poorly/undifferentiated | 0.823 (0.612-1.107) | 0.198 | ||
| T stage | ||||
| 1 | 1 (Reference) | 1 (Reference) | ||
| 2 | 1.171 (0.861-1.593) | 0.314 | 1.449 (1.064-1.975) | 0.019 |
| 3 | 2.376 (1.856-3.041) | < 0.001 | 2.586 (2.012-3.324) | < 0.001 |
| 4 | 3.924 (3.062-5.029) | < 0.001 | 3.852 (2.987-4.967) | < 0.001 |
| N stage | ||||
| 0 | 1 (Reference) | 1 (Reference) | ||
| 1 | 1.230 (1.066-1.419) | 0.005 | 1.534 (1.325-1.777) | < 0.001 |
| 2 | 1.906 (1.660-2.188) | < 0.001 | 2.043 (1.777-2.350) | < 0.001 |
| 3 | 2.496 (2.192-2.841) | < 0.001 | 2.342 (2.049-2.677) | < 0.001 |
| Treatment | ||||
| Surgery alone | 1 (Reference) | 1 (Reference) | ||
| Neoadjuvant chemotherapy | 0.426 (0.380-0.478) | < 0.001 | 0.551 (0.484-0.629) | < 0.001 |
| Adjuvant chemotherapy | 0.519 (0.458-0.587) | < 0.001 | 0.552 (0.484-0.629) | < 0.001 |
- Citation: Li ZF, Li Z, Zhang XJ, Sun CY, Fei H, Du CX, Guo CG, Zhao DB. Perioperative chemotherapy improves survival of patients with locally advanced diffuse gastric cancer. World J Gastrointest Surg 2024; 16(9): 2878-2892
- URL: https://www.wjgnet.com/1948-9366/full/v16/i9/2878.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v16.i9.2878