J Gastric Cancer.  2018 Mar;18(1):69-81. 10.5230/jgc.2018.18.e9.

Survival Benefit of Perioperative Chemotherapy in Patients with Locally Advanced Gastric Cancer: a Propensity Score Matched Analysis

• Eom BW
• Kim S
• Kim JY
• Yoon HM
• Kim MJ
• Nam BH
• Kim YW
• Park YI
• Park SR
• Ryu KW

• KMID: 2414548
• DOI: http://doi.org/10.5230/jgc.2018.18.e9

Abstract

PURPOSE
It has been reported that the survival of patients with locally advanced gastric cancer (LAGC) is better in East Asia countries than in developed western countries; however, the prognosis of LAGC remains poor. This study aimed to evaluate the effects of perioperative chemotherapy on the long-term survival of East Asia patients with LAGC.
MATERIALS AND METHODS
From October 2006 through August 2008, 43 patients with LAGC received perioperative S-1 combined with weekly docetaxel in a phase II study (neoadjuvant group). These patients were matched using propensity scores to patients who underwent surgery without neoadjuvant chemotherapy during the same period (surgery group). The surgical outcomes and long-term survivals were compared between the 2 groups.
RESULTS
After matching, 43 and 86 patients were included in the neoadjuvant and surgery groups, respectively, and there was no significant difference in their baseline characteristics. Although the operating time was longer in the neoadjuvant group, there was no significant difference in postoperative complications between the 2 groups. The neoadjuvant group had a significantly higher 5-year overall survival (OS) rate (73.3% vs. 51.1%, P=0.005) and a trend towards higher 5-year progression-free survival (PFS) (62.8% vs. 49.9%, P=0.145). In the multivariate analysis, perioperative chemotherapy was an independent factor for OS, with a hazard ratio of 0.4 (P=0.005) and a marginal effect on the PFS (P=0.054).
CONCLUSIONS
Perioperative chemotherapy was associated with better long-term survival without increasing postoperative complications in the setting of D2 surgery for patients with LAGC, suggesting that perioperative chemotherapy can be a therapeutic option in East Asia countries.

Keyword

Stomach neoplasm; Neoadjuvant therapy; Chemotherapy Adjuvant; Propensity Score

MeSH Terms

Disease-Free Survival
Drug Therapy*
Far East
Humans
Multivariate Analysis
Neoadjuvant Therapy
Postoperative Complications
Prognosis
Propensity Score*
Stomach Neoplasms*

Figure

• 

  Fig. 1 Flow diagram for the study.

• 

  Fig. 2 Survival curves comparing the perioperative chemotherapy and surgery first groups. (A) OS and (B) PFS are shown. OS = overall survival; PFS = progression-free survival.

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