Comparison of neoadjuvant chemotherapy followed by surgery vs. surgery alone for locally advanced gastric cancer: a meta-analysis

Yu, Jianhong; Wang, Zaozao; Fan, Ying-Chong; Liu, Maoxing; Xu, Kai; Zhang, Nan; Yao, Zhendan; Yang, Hong; Zhang, Cheng-Hai; Xing, Jiadi; Cui, Ming; Su, Xiangqian

doi:10.1097/cm9.0000000000001603

Cited by 16 publications

(15 citation statements)

References 58 publications

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“…In the past decades, the multimodal approach with POC has been widely determined as standard treatment in most European countries 18 , since it increases the survival of patients with advanced GC. However, despite this approach, it is estimated that R0 resection is only achieved in 40–50% of the cases 28 , meaning that most patients will have a relapse or die due to this neoplasm 16 . This can be explained by the aggressive biological behavior of this neoplasm, characteristics of the patients (such as an advanced stage at the moment of diagnosis, advanced age, high BMI, the presence of multiple comorbidities) 8 , and the presence of occult micrometastases, which increases the probability of early invasion of LN 1 .…”

Section: Discussionmentioning

confidence: 99%

Morbidity and Survival After Perioperative Chemotherapy in Gastric Cancer: A Study Using the Becker’s Classification and Regression

Machado

Barbosa

Oliveira

et al. 2022

ABCD, arq. bras. cir. dig.

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BACKGROUND: Gastric cancer is an aggressive neoplasm with a poor prognosis. The multimodal approach with perioperative chemotherapy is currently the recommended treatment for patients with locally advanced gastric cancer. This treatment induces a histopathological response expressed either through the degree of regression of the primary tumor or of the lymph nodes or through yTNM staging. Despite its advantages, there are still doubts regarding the effects of chemotherapy on postoperative morbidity and mortality. AIMS: This study aims to evaluate the impact of perioperative chemotherapy and its effect on anatomopathological results and postoperative morbidity and on patient survival. METHODS: This is an observational retrospective study on 134 patients with advanced gastric cancer who underwent perioperative chemotherapy and curative radical surgery. The degree of histological regression of the primary tumor was evaluated according to Becker’s criteria; the proportion of regressed lymph nodes was determined, and postoperative complications were evaluated according to the Clavien-Dindo classification. Survival times were compared between the groups using Kaplan-Meier curves and the Mantel-Cox log-rank test. RESULTS: In all, 22.3% of the patients were classified as good responders and 75.9% as poor responders. This variable was not correlated with operative morbidity (p=1.68); 64.2% of patients had invaded lymph nodes and 46.3% had regressed lymph nodes; and 49.4% had no lymphatic invasion and 61.9% had no signs of venous invasion. Postoperative complications occurred in 30.6% of the patients. The group of good responders had an average survival of 56.0 months and the group of poor responders had 34.0 months (p=0.17). CONCLUSION: Perioperative chemotherapy induces regression in both the primary tumor and lymph nodes. The results of the operative morbidity were similar to those described in the literature. However, although the group of good responders showed better survival, this value was not significant. Therefore, further studies are needed to evaluate the importance of the degree of lymph node regression and its impact on the survival of these patients.

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Section: Discussionmentioning

confidence: 99%

Morbidity and Survival After Perioperative Chemotherapy in Gastric Cancer: A Study Using the Becker’s Classification and Regression

Machado

Barbosa

Oliveira

et al. 2022

ABCD, arq. bras. cir. dig.

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“…It is worth mentioning that although NAC increases tissue fibrous adhesion and make surgery more challenging, surgical complications and chemotherapy adverse events were comparable in patients receiving NAC and standard treatment, regardless of whether the treatment was doublet or triplet [ 19 ]. A meta-analysis in 2021 reported an even lower anastomotic leakage and reoperation rate in NAC patients than in patients receiving standard treatments [ 20 ].…”

Section: Evidence On Nac In Locally Agcmentioning

confidence: 99%

Neoadjuvant Chemotherapy in Asian Patients With Locally Advanced Gastric Cancer

2023

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Presently, surgery is the only treatment approach for gastric cancer and improving the prognosis of locally advanced gastric cancer is one of the key factors in promoting gastric cancer survival benefit. The MAGIC study was the first to demonstrate the efficacy of neoadjuvant chemotherapy (NAC) in European countries. In recent years, several clinical trials have provided evidence for the use of NAC in Asian patients with locally advanced gastric cancer. However, clinical practice guidelines vary between Asian and non-Asian populations. Optimal NAC regimens, proper target populations, and predictors of NAC outcomes in Asian patients are still under investigation. Herein, we summarized the current progress in the administration of NAC in Asian patients with gastric cancer.

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“… 19 For locally advanced gastrointestinal malignancies that are difficult to surgery directly, so neoadjuvant chemotherapy strategies have been proposed in recent decades, which greatly improve the feasibility of surgery and R0 resection rate, thus significantly prolonging survival. 20 For pancreatic cancer with highly prone to recurrence after surgery, the pioneering ESPAC‐1 study explored the effects of adjuvant chemotherapy. 21 The results showed that 5‐fluorouracil combined with calcium leucovorin improved the 5‐year OS rate to 21%, compared to only 8% with surgery alone.…”

Section: Introductionmentioning

confidence: 99%

Hyperthermia combined with immune checkpoint inhibitor therapy: Synergistic sensitization and clinical outcomes

Liu

et al. 2022

Cancer Medicine

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Background Within the field of oncotherapy, research interest regarding immunotherapy has risen to the point that it is now seen as a key application. However, inherent disadvantages of immune checkpoint inhibitors (ICIs), such as their low response rates and immune‐related adverse events (irAEs), currently restrict their clinical application. Were these disadvantages to be overcome, more patients could derive prolonged benefits from ICIs. At present, many basic experiments and clinical studies using hyperthermia combined with ICI treatment (HIT) have been performed and shown the potential to address the above challenges. Therefore, this review extensively summarizes the knowledge and progress of HIT for analysis and discusses the effect and feasibility. Methods In this review, we explored the PubMed and clinicaltrials.gov databases, with regard to the searching terms “immune checkpoint inhibitor, immunotherapy, hyperthermia, ablation, photothermal therapy”. Results By reviewing the literature, we analyzed how hyperthermia influences tumor immunology and improves the efficacy of ICI. Hyperthermia can trigger a series of multifactorial molecular cascade reactions between tumors and immunization and can significantly induce cytological modifications within the tumor microenvironment (TME). The pharmacological potency of ICIs can be enhanced greatly through the immunomodulatory amelioration of immunosuppression, and the activation of immunostimulation. Emerging clinical trials outcome regarding HIT have verified and enriched the theoretical foundation of synergistic sensitization. Conclusion HIT research is now starting to transition from preclinical studies to clinical investigations. Several HIT sensitization mechanisms have been reflected and demonstrated as significant survival benefits for patients through pioneering clinical trials. Further studies into the theoretical basis and practical standards of HIT, combined with larger‐scale clinical studies involving more cancer types, will be necessary for the future

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Comparison of neoadjuvant chemotherapy followed by surgery vs. surgery alone for locally advanced gastric cancer: a meta-analysis

Abstract: Supplemental Digital Content is available in the text

Cited by 16 publications

References 58 publications

Morbidity and Survival After Perioperative Chemotherapy in Gastric Cancer: A Study Using the Becker’s Classification and Regression

Morbidity and Survival After Perioperative Chemotherapy in Gastric Cancer: A Study Using the Becker’s Classification and Regression

Neoadjuvant Chemotherapy in Asian Patients With Locally Advanced Gastric Cancer

Hyperthermia combined with immune checkpoint inhibitor therapy: Synergistic sensitization and clinical outcomes

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