Adjuvant Chemotherapy Associated With Improved Survival in Locally Advanced Gastric Cancer

Adjuvant chemotherapy was associated with improved 3-year overall survival (OS) (46.6% vs 21.7%; P <.001) in patients with locally advanced gastric cancer with a lymph node ratio of 9% or greater, but not for those with a lymph node ratio of less than 9% (73.9% vs 71.3%; P = .3), according to results from a retrospective study.

“Neoadjuvant chemotherapy is a standard treatment option for locally advanced gastric cancer; the indications for adjuvant chemotherapy in patients with locally advanced gastric cancer who received neoadjuvant chemotherapy remain controversial,” wrote lead author Jian-Xian Lin, PhD, Fujian Medical University Union Hospital, Fuzhou, China, and colleagues.

In the multicenter study, researchers analyzed data from 353 patients with locally advanced gastric cancer undergoing curative-intent gastrectomy after neoadjuvant chemotherapy at 2 tertiary referral teaching hospitals in China between June 1, 2008, and December 31, 2017, 74.1% of whom received adjuvant chemotherapy, while 25.9% did not.

All patients received fluorouracil-based neoadjuvant chemotherapy and were routinely recommended to receive adjuvant chemotherapy after surgery.

Researchers also examined data on 109 patients treated in the United States and Italy from 2 cohorts (88 patients from the Mayo Clinic and 21 from the International Study Group on Minimally Invasive Surgery for GASTRIC Cancer trial) between June 1, 2006, and June 30, 2013, to validate their findings. Follow-up was completed for the Chinese cohort in December 2020, and between February and July 2017 for the western cohort. The data analysis was performed from December 1, 2020, to February 28, 2021.

Analysis of the Western cohort confirmed that adjuvant chemotherapy was associated with improved 3-year OS in patients with an lymph node ratio of 9% or greater (53% vs 26.3%; P = .04).

Only those patients who completed at least 4 cycles of adjuvant chemotherapy demonstrated a significant survival benefit in the 6-month (HR, 0.56; 95% CI, 0.33-0.96; p=.03) and 9-month analysis (HR, 0.50; 95% CI, 0.27 to 0.94; P = .03).

Source:
Lin J, Tang Y, Lin G, et al. Association of Adjuvant Chemotherapy With Overall Survival Among Patients With Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy. JAMA Netw Open. 2022 Apr 1;5(4):e225557. doi:10.1001/jamanetworkopen.2022.5557.