Perioperative and adjuvant chemotherapy on survival in advanced gastric cancer following gastrectomy with D2 lymphadenectomy
DOI:
https://doi.org/10.47892/rgp.2025.452.1762Keywords:
Stomach Neoplasms, Gastrectomy, Lymph Node Excision, Drug Therapy, Chemotherapy, Adjuvant, survivalAbstract
Objective: To describe the effectiveness of perioperative chemotherapy and adjuvant chemotherapy in the survival of patients with gastric carcinoma after gastrectomy with D2 lymphadenectomy (T2-T4a) and to determine the association between the intervening factors of the study and the survival of this group. Materials and methods: Observational study, retrospective cohorts, in patients who received perioperative or adjuvant chemotherapy at a Peruvian cancer institute from January 2007 to December 2022. To determine actuarial survival, the Kaplan-Meier method and the log-rank test were used to compare 2 survival curves. Results: A total population of 82 patients was evaluated, of which 46 received adjuvant chemotherapy and 36 perioperative chemotherapy, with the most commonly used regimen being CAPOX and EOX/EOX, respectively. Clinical characteristics did not significantly influence overall survival and only the primary tumor (T) had a statistically significant association, with T4a being more frequent in the perioperative chemotherapy group than in the adjuvant modality group (80.6% vs 47.8%; p=0.002). When comparing both therapeutic modalities, it was evident that patients who received perioperative chemotherapy had a longer survival at 5 years (53.2%), however, this was not statistically significant (p=0.230). Conclusions: Perioperative chemotherapy presented greater survival compared to adjuvant chemotherapy at 12, 36 and 60 months; however, these differences were not statistically significant.
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Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251):635-648. doi: 10.1016/ S0140-6736(20)31288-5.
López MJ, Carbajal J, Alfaro AL, Saravia LG, Zanabria D, Araujo JM, et al. Characteristics of gastric cancer around the world. Crit Rev Oncol Hematol. 2023;181:103841. doi: 10.1016/j. critrevonc.2022.103841.
American Cancer Society. Cancer Facts & Figures 2023 [Internet]. Atlanta: American Cancer Society Inc.; 2023 [citado 15 de enero de 2024]. Disponible en: https://www.cancer.org/ research/cancer-facts-statistics/all-cancer-facts-figures/2023- cancer-facts-figures.html
Wong MCS, Huang J, Chan PSF, Choi P, Lao XQ, Chan SM, et al. Global Incidence and Mortality of Gastric Cancer, 1980- 2018. JAMA Netw Open. 2021;4(7):e2118457. doi: 10.1001/ jamanetworkopen.2021.18457.
Ruiz EF, Torres-Roman JS, Servan SA, Martinez-Herrera JF, Arce-Huamani MA, Carioli G, et al. Trends and geographic pattern of stomach cancer mortality in Peru. Cancer Epidemiol. 2019;58:193-198. doi: 10.1016/j.canep.2018.10.018.
National Cancer Institute. Stomach Cancer Survival Rates and Statistics - NCI [Internet]. Bethesda, MD: NCI; 2023 [citado 21 de enero de 2024]. Disponible en: https://www.cancer.gov/ types/stomach/survival
Cancer Genome Atlas Research Network. Comprehensive molecular characterization of gastric adenocarcinoma. Nature. 2014;513(7517):202-9. doi: 10.1038/nature13480.
Strong VE. Progress in gastric cancer. Updates Surg. 2018;70(2):157-159. doi: 10.1007/s13304-018-0543-3.
Griniatsos J, Trafalis D. Differences in gastric cancer surgery outcome between East and West: differences in surgery or different diseases? J BUON. 2018 Sep-Oct;23(5):1210-1215.
Joshi SS, Badgwell BD. Current treatment and recent progress in gastric cancer. CA Cancer J Clin. 2021;71(3):264-279. doi: 10.3322/caac.21657.
Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26(1):1-25. doi: 10.1007/s10120-022-01331-8.
Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014;15(12):1389-96. doi: 10.1016/S1470-2045(14)70473-5.
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810-20. doi: 10.1056/NEJMoa072252.
Serrano M, Araujo JM, Pacheco C, Macetas J, Blum MA, Carrato A, et al. Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer. Ecancermedicalscience. 2022;16:1387. doi: 10.3332/ ecancer.2022.1387.
Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006 Jul 6;355(1):11-20. doi: 10.1056/NEJMoa055531. PMID: 16822992.
Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1;29(13):1715-21. doi: 10.1200/JCO.2010.33.0597.
Bolla M, van Poppel H, Tombal B, Vekemans K, Da Pozzo L, de Reijke TM, et al. European Organisation for Research and Treatment of Cancer, Radiation Oncology and GenitoUrinary Groups. Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet. 2012 Dec 8;380(9858):2018-27. doi: 10.1016/S0140- 6736(12)61253-7.
Campillo J, Suárez L, Guevara R, Burgos R, Villegas C, Cendales M, et al. Supervivencia y complicaciones en pacientes con cáncer gástrico y de la unión gastroesofágica tratados con quimioterapia perioperatoria más cirugía comparada con cirugía más terapia adyuvante: estudio multicéntrico, Bogotá D.C., 2010-2017. Rev Colomb Cir. diciembre de 2018;33(4):353- 61. doi: 10.30944/20117582.82.
Yang Y, Yin X, Sheng L, Xu S, Dong L, Liu L. Perioperative chemotherapy more of a benefit for overall survival than adjuvant chemotherapy for operable gastric cancer: an updated Meta-analysis. Sci Rep. 2015 Aug 5;5:12850. doi: 10.1038/srep12850.
Aoyama T, Yoshikawa T, Watanabe T, Hayashi T, Ogata T, Cho H, et al. Macroscopic tumor size as an independent prognostic factor for stage II/III gastric cancer patients who underwent D2 gastrectomy followed by adjuvant chemotherapy with S-1. Gastric Cancer. 2011;14(3):274-8. doi: 10.1007/s10120-011-0038-0.
Karagkounis G, Squires MH, Melis M, Poultsides GA, Worhunsky D, Jin LX, et al. Predictors and Prognostic Implications of Perioperative Chemotherapy Completion in Gastric Cancer. J Gastrointest Surg. 2017;21(12):1984-1992. doi: 10.1007/ s11605-017-3594-8.
Guan WL, He Y, Xu RH. Gastric cancer treatment: recent progress and future perspectives. J Hematol Oncol. 2023 May 27;16(1):57. doi: 10.1186/s13045-023-01451-3.
Giampieri R, Baleani MG, Bittoni A, Rastelli F, Catalano V, Del Prete M, et al. Impact of Signet-Ring Cell Histology in the Management of Patients with Non-Metastatic Gastric Cancer: Results from a Retrospective Multicenter Analysis Comparing FLOT Perioperative Chemotherapy vs. Surgery Followed by Adjuvant Chemotherapy. Cancers (Basel). 2023;15(13):3342. doi: 10.3390/cancers15133342.
Jiang Y, Xie J, Huang W, Chen H, Xi S, Li T, et al. Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Gastric Cancer. Clin Transl Gastroenterol. 2020 Oct;11(10):e00253. doi: 10.14309/ctg.0000000000000253.
Slagter AE, Tudela B, van Amelsfoort RM, Sikorska K, van Sandick JW, van de Velde CJH, et al. Older versus younger adults with gastric cancer receiving perioperative treatment: Results from the CRITICS trial. Eur J Cancer. 2020 May;130:146- 154. doi: 10.1016/j.ejca.2020.02.008.
Jun KH, Jung H, Baek JM, Chin HM, Park WB. Does tumor size have an impact on gastric cancer? A single institute experience. Langenbecks Arch Surg. julio de 2009;394(4):631- 5.
Zhao J hua, Gao P, Song Y xi, Sun J xu, Chen X wan, Ma B, et al. Which is better for gastric cancer patients, perioperative or adjuvant chemotherapy: a meta-analysis. BMC Cancer. 2016;16:631. doi: 10.1186/s12885-016-2667-5.
Kang YK, Yook JH, Park YK, Lee JS, Kim YW, Kim JY, et al. PRODIGY: A Phase III Study of Neoadjuvant Docetaxel, Oxaliplatin, and S-1 Plus Surgery and Adjuvant S-1 Versus Surgery and Adjuvant S-1 for Resectable Advanced Gastric Cancer. J Clin Oncol. 2021;39(26):2903-2913. doi: 10.1200/ JCO.20.02914.
Rougier P, Mahjoubi M, Lasser P, Ducreux M, Oliveira J, Ychou M, et al. Neoadjuvant chemotherapy in locally advanced gastric carcinoma--a phase II trial with combined continuous intravenous 5-fluorouracil and bolus cisplatinum. Eur J Cancer Oxf Engl 1990. 1994;30A(9):1269-75.
Wilke H, Preusser P, Fink U, Gunzer U, Meyer HJ, Meyer J, et al. Preoperative chemotherapy in locally advanced and nonresectable gastric cancer: a phase II study with etoposide, doxorubicin, and cisplatin. J Clin Oncol Off J Am Soc Clin Oncol. septiembre de 1989;7(9):1318-26.
Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy witouchh fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet Lond Engl. 11 de mayo de 2019;393(10184):1948-57.
Kang YK, Yook JH, Park YK, Lee JS, Kim YW, Kim JY, et al. PRODIGY: A Phase III Study of Neoadjuvant Docetaxel, Oxaliplatin, and S-1 Plus Surgery and Adjuvant S-1 Versus Surgery and Adjuvant S-1 for Resectable Advanced Gastric Cancer. J Clin Oncol. 2021 Sep 10;39(26):2903-2913. doi: 10.1200/JCO.20.02914.
Messager M, Lefevre JH, Pichot-Delahaye V, Souadka A, Piessen G, Mariette C, et al. The Impact of Perioperative Chemotherapy on Survival in Patients With Gastric Signet Ring Cell Adenocarcinoma: A Multicenter Comparative Study. Ann Surg. noviembre de 2011;254(5):684.
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Copyright (c) 2025 Cesia J. Luna-Córdova, Juan Alberto Díaz-Plasencia, Edgar Fermín Yan-Quiroz, José Richard Tenazoa-Villalobos

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