Francesco Abboretti, Céline Lambert, Markus Schäfer, Bruno Pereira, Bertrand Le Roy, Diane Mège, Guillaume Piessen, Johan Gagnière, Caroline Gronnier, Styliani Mantziari; ADENOKGAST Study Group; AFC-French Association of Surgery
Abstract
Background
According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences.
Objective
The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients.
Methods
A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups.
Results
Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p < 0.001) and had a better health status (World Health Organization performance status = 0 in 60.3% of CS patients vs. 34.5% of S patients; p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW.
Conclusions
Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
Keywords: Neoadjuvant therapy; Propensity score; Stomach neoplasms; Survival analysis.
© 2024. The Author(s).
Abboretti F, Lambert C, Schäfer M, Pereira B, Le Roy B, Mège D, Piessen G, Gagnière J, Gronnier C, Mantziari S; ADENOKGAST Study Group; AFC-French Association of Surgery. Neoadjuvant Chemotherapy Does Not Improve Survival in cT2N0M0 Gastric Adenocarcinoma Patients: A Multicenter Propensity Score Analysis. Ann Surg Oncol. 2024 Aug;31(8):5273-5282. doi: 10.1245/s10434-024-15418-2. Epub 2024 May 18. PMID: 38762640; PMCID: PMC11236876.
