Impact of the time from the completion of neoadjuvant chemotherapy to surgery on the outcomes of patients with gastric cancer

Wu, Chaorui; Zhou, Hong; Wang, Tongbo; Zhang, Xiaojie; Chen, Yingtai; Zhao, Dongbing

doi:10.21037/tcr.2019.08.42

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…In contrast to the findings of Liu et al (11), a relative short-term interval before surgery (3-5 weeks) was an independent protective factor for OS and PFS with no statistical pathologic improvement. Our results are contrary to previous findings relating to rectal and esophageal cancer, in which longer waiting time is believed to achieve a better pathological response (6,8,(28)(29)(30).…”

Section: Discussioncontrasting

confidence: 99%

“…Time interval to surgery after the completion of NACT is a common question asked by patients with GC, but it is a question without a definite answer. There have only been a few retrospective studies on this topic with limited sample size, and these have come to different conclusions (10,11,25). Liu et al (10) first presented a retrospective study of 176 patients with GC and proposed that prolonged interval time of >6 weeks was associated with an increased rate of pCR but not with OS or DFS.…”

Section: Discussionmentioning

confidence: 99%

“…However, the notable rate of pCR might require further investigation as it is recognized that pCR rate is relatively low in gastric or esophagogastric junction cancer after NACT, usually no more than 10% (26,27). Using similar methodologies and cut-off values, Wu et al (11) reviewed 229 cases in which the NACT to surgery interval time had no impact on the survival benefit. The entire pCR rate was 7.0% in their study, including 5.71% (4/70), 5.83% (6/103), and 10.71% (6/56) in trichotomous groups.…”

Section: Discussionmentioning

confidence: 99%

“…Studies of other gastrointestinal neoplasms such as esophageal and rectal cancer found a better survival benefit or pathological response rate in patients with longer time to surgery (TTS) (6)(7)(8)(9). Comparable studies in GC patients have shown no effect on OS or DFS, while the improvement in pathologic complete response (pCR) is significantly higher in patients with longer TTS (10,11). However, the conclusion regarding pathological improvement was based on a retrospective study and a relatively small sample size with only 17 of 176 patients in the >6 weeks group.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

et al. 2020

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BackgroundThe relationship between time to surgery (TTS) and survival benefit is not sufficiently demonstrated by previous studies in locally advanced gastric cancer (LAGC). This study aims to assess the impact of TTS after neoadjuvant chemotherapy (NACT) on long-term and short-term outcomes in LAGC patients.MethodsData were collected from patients with LAGC who underwent NACT between January 2007 and January 2018 at our institution. Outcomes assessed were long-term survival, pathologic complete response (pCR) rate, and postoperative complications.ResultsThis cohort of 426 patients was divided into five groups by weeks of TTS. Under cox regression, compared to other groups, the 22–28 days and 29–35 days groups revealed a better OS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.185; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.004; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.022) and PFS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.256; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.111; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.047). Further analysis revealed a better prognosis in patients with TTS within 22–35 days (OS: HR 1.78 95% CI = 1.25−2.54, P = 0.001; PFS: HR 1.49, 95% CI = 1.07−2.08, P = 0.017). Postoperative stay was significantly higher in the ≤21 days group, while other parameters revealed no statistical significance (P > 0.05). Restricted cubic spline depicted the nonlinear relationship between TTS and OS/PFS.ConclusionPatients who received surgery within 3−5 weeks experienced the maximal survival benefit without an increase in postoperative complications or lowering the rate of pCR. Further investigations are warranted.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

et al. 2020

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“…The propensity score matching in this study was performed between high TTS patients and low TTS patients to eliminate the bias from the impact of this factor on survival. In addition, other studies suggested the most common factors for delayed operation included heavily economic level of patients, the management of health insurance, and the busy turnover of beds in hospital 36,37 …”

Section: Discussionmentioning

confidence: 99%

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

et al. 2020

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Background Neoadjuvant chemotherapy (NAC) has been widely performed in the treatment of colorectal cancer liver metastasis (CRLM) patients, but the optimal timing of surgery after NAC is unclear. The aim of this study was to investigate the optimal timing of surgery. Methods From December 2010 to May 2018, 101 consecutive patients who received NAC followed by liver resection for CRLM were included in this study. The main outcome parameters were pathological response, progression‐free survival (PFS), and overall survival (OS). The effect of time to surgery (TTS) on patient outcomes, defined as a high TTS and a low TTS according to an X‐tile analysis, was investigated. To adjust for potential selection bias, propensity score matching at 1:2 was performed with two high TTS patients matched to one low TTS patient. Kaplan‐Meier curves, logistic regression analyses, and Cox regression models were used for the data analysis. Results The optimal cut‐off value for the TTS was 5 weeks by X‐tile analysis. The patients in this study were divided into low (≤5 weeks, n = 27) and high (>5 weeks, n = 74) TTS groups. Patients with a high TTS were more likely to have an unfavorable pathological response (75.7% vs 48.1%, P = .008). In multivariate analysis, a low TTS significantly predicted a better pathological response (OR = 3.397, 95% CI: 1.116‐10.344, P = .031). Compared to patients with a high TTS, patients with a low TTS had significantly better PFS (P < .001, mPFS: 16 months vs 7 months) and better OS (P = .037, mOS: not reached vs 36 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 2.041, 95% CI: 1.152‐3.616, P = .014) but not OS. After propensity matching, the patients with a low TTS had significantly better PFS (P < .001, mPFS: 18.2 months vs 10 months) and an equivalent OS (P = .115, mOS: not reached vs 41 months). Multivariate analysis revealed that a TTS > 5 weeks was an independent predictor of decreased PFS (HR = 3.031, 95% CI: 1.494‐6.149, P = .002) but not OS. Conclusion The longer TTS after the completion of NAC may be disadvantageous for a favorable pathological response and long‐term PFS. These results should be validated prospectively in a randomized trial.

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Optimal timing of surgery for gastric cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis

Ling,

Huang,

et al. 2023

World J Surg Onc

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Background Following neoadjuvant chemotherapy, surgical resection is one of the most preferred treatment options for locally advanced gastric cancer patients. However, the optimal time interval between chemotherapy and surgery is unclear. This review aimed to identify the optimal time interval between neoadjuvant chemotherapy and surgery for advanced gastric cancer. Methods Beginning on November 12, 2022, we searched the PubMed, Cochrane Library, Web of Science databases, and Embase.com databases for relevant English-language research. Two authors independently screened the studies, assessed their quality, extracted the data, and analyzed the results. The primary goal was to investigate the relationship between the time interval to surgery (TTS) and long-term survival outcomes for patients. This study has been registered with PROSPERO (CRD42022365196). Results After an initial search of 4880 articles, the meta-analysis review ultimately included only five retrospective studies. Ultimately, this meta-analysis included 1171 patients, of which 411 patients had TTS of < 4 weeks, 507 patients had TTS of 4–6 weeks, and 253 patients had TTS of > 6 weeks. In survival analysis, patients with TTS of > 6 weeks had poorer overall survival outcomes than patients with TTS of 4–6 weeks (HR = 1.34, 95% CI: 1.03–1.75, P = 0.03). No significant differences were found in terms of disease-free survival the groups. Conclusion Based on the current clinical evidence, patients with locally advanced gastric cancer may benefit better with a TTS of 4–6 weeks; however, this option still needs additional study.

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Impact of the time from the completion of neoadjuvant chemotherapy to surgery on the outcomes of patients with gastric cancer

Cited by 7 publications

References 23 publications

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

From the completion of neoadjuvant chemotherapy to surgery for colorectal cancer liver metastasis: What is the optimal timing?

Optimal timing of surgery for gastric cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis

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