Adjuvant chemotherapy for node-negative gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy: A propensity score matched analysis study

Enoch Wong; Sivesh K Kamarajah; Fadi Dahdaleh; Samer Naffouje; Victoria Kunene; David Fackrell; Ewen A Griffiths

doi:10.1016/j.ejso.2024.109506

Adjuvant chemotherapy for node-negative gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy: A propensity score matched analysis study

Eur J Surg Oncol. 2024 Dec 20;51(3):109506. doi: 10.1016/j.ejso.2024.109506. Online ahead of print.

Authors

Enoch Wong¹, Sivesh K Kamarajah², Fadi Dahdaleh³, Samer Naffouje⁴, Victoria Kunene⁵, David Fackrell⁵, Ewen A Griffiths⁶

Affiliations

¹ Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.
² Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
³ Department of Surgical Oncology, Edward-Elmshurst Health, Naperville, IL, USA.
⁴ Department of General Surgery, Cleveland Clinic Main Campus, Cleveland, OH, USA.
⁵ Department of Oncology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK.
⁶ Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: ewen.griffiths@uhb.nhs.uk.

PMID: 39756161
DOI: 10.1016/j.ejso.2024.109506

Abstract

Introduction: The long term survival of patients undergoing curative resection for gastric cancer remains poor owing to high recurrence rates. The use of adjuvant chemotherapy in node positive gastric cancer to prolong survival and prevent recurrence is widely accepted. However, the role for adjuvant chemotherapy in node negative gastric cancer is less clear, particularly in the era of neoadjuvant chemotherapy.

Objective: To determine the association of adjuvant chemotherapy with survival in patients undergoing pathologically node negative gastric cancer resection, following neoadjuvant chemotherapy.

Methods: We examined a national cancer database containing patients who had undergone neoadjuvant chemotherapy and pathologically node negative curative gastrectomy. We divided these patients into those who had undergone adjuvant chemotherapy versus those who had not. Using a propensity score matched analysis, we analyzed the survival of these patients between the 2 groups.

Results: 5309 patients who had undergone curative gastrectomy were identified from the database and 806 of these patients were given adjuvant chemotherapy. Following propensity score matched analysis, patients who had been given adjuvant chemotherapy had an increased median survival of 150 vs 125 months (5-year 68 % vs 62 %, p < 0.001).

Conclusion: There is a small, but statistically significant survival benefit for adjuvant chemotherapy in patients with node negative gastric cancer who had undergone neoadjuvant chemotherapy. Further studies are required to examine the role of adjuvant chemotherapy in this subset of patients.

Keywords: Adjuvant chemotherapy; Gastrectomy; Neoadjuvant chemotherapy; Outcomes.