AI Article Synopsis
- Neoadjuvant chemotherapy (NAC) and chemoradiation (NCRT) are treatments for locoregional gastric cancer, but their effectiveness in improving survival is still debated.
- In a study analyzing data from 9,831 patients, NCRT led to better histopathologic outcomes like pathologic complete response and margin-negative resections, while NAC showed improved overall survival rates.
- Further research is necessary to understand how histologic assessments after neoadjuvant therapy can impact prognostication for patients with gastric cancer.
Article Abstract
Unlabelled: BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NAC) and chemoradiation (NCRT) have demonstrated improved survival for gastric cancer. However, the optimal neoadjuvant treatment remains unclear. We sought to evaluate perioperative and histopathologic outcomes among neoadjuvant treatments for locoregional gastric cancer.
Methods: The National Cancer Database queried patients who received NAC or NCRT followed by resection for T2-T4 and/or node-positive gastric cancer (2006-2018). Logistic and Poisson regression assessed perioperative (30-day readmission, 30- and 90-day mortality, length of stay [LOS]) and histopathologic outcomes (pathologic complete response [PCR], margin status, and negative pathologic lymph nodes [ypN0]). Kaplan-Meier methods and Cox regression assessed overall survival (OS).
Results: Of 9831 patients, 4221 (42.9%) received NAC and 5610 (57.1%) NCRT. There were no differences in perioperative outcomes, apart from patients treated with NCRT exhibiting increased LOS (incidence rate ratio 1.09, 95% confidence interval [CI] 1.03-1.16). Patients who received NCRT were more likely to achieve PCR, margin-negative resection, and ypN0 (all p < 0.05). Median OS was 36.8 months for NAC and 33.6 months for NCRT (p < 0.001). NCRT independently predicted worse OS (vs. NAC, hazard ratio 1.10, 95% CI 1.03-1.18).
Conclusion: NCRT was associated with better histologic tumor response although NAC was associated with improved OS. Better understanding prognostication through histologic assessment following neoadjuvant therapy is needed.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10872619 | PMC |
| http://dx.doi.org/10.1002/jso.27521 | DOI Listing |
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