Does resection after neoadjuvant chemotherapy of docetaxel, oxaliplatin, and S-1 (DOS regimen) benefit for gastric cancer patients with single non-curable factor? a multicenter, prospective cohort study (Neo-REGATTA)

Abstract

Background The Neo-REGATTA study evaluated the effectiveness and safety of Docetaxel, oxaliplatin, and S-1 (DOS regimen) followed by radical resection vs. chemotherapy in advanced gastric adenocarcinoma patients with single non-curable factor. Methods This cohort study prospectively enrolled advanced gastric adenocarcinoma patients with single non-curable factor between November 2017 and June 2021. Patients without progression after four cycles of DOS were divided into resection group and chemotherapy group. The outcomes included overall survival (OS), progression-free survival (PFS) and safety. Effectiveness analysis was also performed by propensity score matching (PSM). Results A total of 73 patients were enrolled and 13 patients were withdrawn due to disease progression after 4 cycles of DOS. Afterwards, 35 and 25 participants were in the resection and chemotherapy groups, respectively. After a median follow-up time of 30.0 months, the median PFS and OS were 9.0 months, and 18.0 months for the chemotherapy group, but not reached in the resection group. After PSM, 19 matched participants were in each group, and the median PFS and OS were longer in resection group than that in chemotherapy group. The most common grade 3 or 4 adverse events both in the resection group and chemotherapy groups were neutropenia (5.7%, 8.0%) and leukopenia (5.7%, 8.0%). Conclusions Radical resection might provide survival benefit compared with continuous chemotherapy alone in advanced gastric adenocarcinoma patients who had a disease control after DOS, with a good safety profile. Trial registration The study protocol was registered on ClinicalTrial.gov (NCT03001726, 23/12/2016).

Survival benefits of gastrectomy in patients with metastatic gastric cancer: A meta-analysis

“…Data on the 2-year OS rate for 1,877 patients were given in 12 studies. 24,29,31,35,38,39,45,46,48,52,56,65 A significantly higher 2-year OS rate was observed through combined analysis in the gastrectomy ± metastasectomy group in contrast to the corresponding rate in the non-resection group (pooled RR: 4.77, 95% CI: 3.12, 7.27, p < 0.001) (Table 1, Fig. 3C, Supplementary Fig.…”

“…In the current study, patients who received gastrectomy were grouped into the gastrectomy group, gastrectomy + metastasectomy group or gastrectomy ± metastasectomy group, and patients who did not receive resection were classified into the non-resection group. In this regard, 16 studies 23,28,30,32,37,40,42,44,50,51,53,55,59,61,63,64 made comparisons between the gastrectomy group and the non-resection group, 8 studies 22,25,34,41,43,54,60,66 compared the gastrectomy + metastasectomy group with the non-resection group, and 22 studies 24,26,27,29,31,33,35,36,38,39,[45][46][47]48,49,52,[56][57][58]62,65,67 compared the gastrectomy ± metastasectomy group with the non-resection group. Of 46 cohort studies, 30 were of medium quality and 16 had high quality.…”

“…Twelve studies, 24,27,29,31,35,38,39,45,46,52,58,65 including 2,475 individuals, compared the 1-year OS rate of the gastrectomy ± metastasectomy and non-resection groups. After the combined analysis, the gastrectomy ± metastasectomy group was found to have a significantly increased 1-year OS rate than the non-resection group (pooled RR: 2.65, 95% CI: 1.95, 3.61, p < 0.001) (Fig.…”