A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data.

Xue Wei Ding; Zhi Chao Zheng; Qun Zhao; Gang Zhai; Han Liang; Xin WU; Zheng Gang Zhu; Hai Jiang Wang; Qing Si HE; Xian Li HE; Yi An DU; Lu Chuan Chen; Ya Wei Hua; Chang Ming Huang; Ying Wei Xue; Ye Zhou; Yan Bing Zhou; Dan WU; Xue Dong Fang; You Guo Dai; Hong Wei Zhang; Jia Qing Cao; Le Ping LI; Jie Chai; Kai Xiong Tao; Guo Li LI; Zhi Gang Jie; Jie GE; Zhong Fa XU; Wen Bin Zhang; Qi Yun LI; Ping Zhao; Zhi Qiang MA; Zhi Long Yan; Guo Liang Zheng; Yang Yan; Xiao Long Tang; Xiang Zhou

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A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data.

Author: Xue Wei DING ¹ ; Zhi Chao ZHENG ² ; Qun ZHAO ³ ; Gang ZHAI ⁴ ; Han LIANG ¹ ; Xin WU ⁵ ; Zheng Gang ZHU ⁶ ; Hai Jiang WANG ⁷ ; Qing Si HE ⁸ ; Xian Li HE ⁹ ; Yi An DU ¹⁰ ; Lu Chuan CHEN ¹¹ ; Ya Wei HUA ¹² ; Chang Ming HUANG ¹³ ; Ying Wei XUE ¹⁴ ; Ye ZHOU ¹⁵ ; Yan Bing ZHOU ¹⁶ ; Dan WU ¹⁷ ; Xue Dong FANG ¹⁸ ; You Guo DAI ¹⁹ ; Hong Wei ZHANG ²⁰ ; Jia Qing CAO ²¹ ; Le Ping LI ²² ; Jie CHAI ²³ ; Kai Xiong TAO ²⁴ ; Guo Li LI ²⁵ ; Zhi Gang JIE ²⁶ ; Jie GE ²⁷ ; Zhong Fa XU ²⁸ ; Wen Bin ZHANG ²⁹ ; Qi Yun LI ³⁰ ; Ping ZHAO ³¹ ; Zhi Qiang MA ³² ; Zhi Long YAN ³³ ; Guo Liang ZHENG ¹ ; Yang YAN ⁵ ; Xiao Long TANG ⁸ ; Xiang ZHOU ³
Author Information

1. Department of Gastric surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Prevention and Therapy, Tianjin 300060, China.
2. Department of Gastric Surgery, Cancer Hospital of China Medical University (Liaoning Cancer Hospital and Institute), Shenyang 110042, China.
3. The Third Department of Surgery, The Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, China.
4. Department of General Surgery, Shanxi Provincial Tumor Hospital, Taiyuan 030013, China.
5. Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
6. Department of Surgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai 200025, China.
7. Department of Gastrointestinal Surgery, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi 830011, China.
8. Department of General Surgery, Qilu Hospital of Shandong University, Jinan 250012, China.
9. Department of General Surgery, Tangdu Hospital, The Air Force Medical University, Xi'an 710038, China.
10. Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.
11. Department of Gastrointestinal Surgery, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou 350014, China.
12. Department of General Surgery, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China.
13. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350004, China.
14. Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China.
15. Department of Gastic Surgery, Afiliated CancerHospital, Fudan University, Shanghai 200030, China.
16. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, China.
17. Department of Gastrointestinal Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China.
18. Department of Gastrointestinal Colorectal And Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China.
19. Department of Gastrointestinal Surgery, Yunnan Cancer Hospital, Kunming 650118, China.
20. Diagnosis and Treatment Center of Digestive Disease, Wuxi Mingci cardiovascular Hospital, Wuxi 214101, China.
21. Department of Gastrointestinal Surgery, Second Affiliated Hospital, Nanchang University, Nanchang 330006, China.
22. Department of Gastrointestinal Surgery, The Affiliated Provincial Hospital, Shandong First Medical University, Jinan 250021, China.
23. Department of Gastric Surgery, The Affiliated Shandong Tumor Hospital, Shandong University, Jinan 250117, China.
24. Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
25. Department of General Surgery, Jinling Hospital/General Hospital of Eastern Theater Command, School of Medicine, Nanjing University, Nanjing 210002, China.
26. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
27. Department of Gastrointestinal Surgery Xiangya Hospital of Central South University, Changsha 410008, China.
28. Department of General Surgery, The Affiliated Hospital, Shandong Academy of Medical Sciences, Jinan 250031, China.
29. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China.
30. Departerment of Abdominal Surgery, Jiangxi Cancer Hospital, Nanchang 330029, China.
31. Departerment of Gastrointestinal Surgery, Sichuan Tumor Hospital, Chengdu 610041, China.
32. Department of General Surgery, Peking Uninon Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing 100730, China.
33. Department of Gastrointestinal Surgery, Ningbo First Hospital, Ningbo 315000, China.
Publication Type:Multicenter Study
Keywords: Neoadjuvant chemotherapy; Overall survival; Progression free survival; Propensity score matched (PSM); Real world study; Stomach neoplasms
MeSH: Chemotherapy, Adjuvant; Female; Gastrectomy; Humans; Male; Neoadjuvant Therapy; Neoplasm Staging; Prognosis; Retrospective Studies; Stomach Neoplasms/surgery*
From: Chinese Journal of Gastrointestinal Surgery 2021;24(5):403-412
CountryChina
Language:Chinese
Abstract: Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.