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Published in: Annals of Surgical Oncology 2/2024

20-11-2023 | Gastric Cancer | Gastrointestinal Oncology

Neoadjuvant Chemotherapy Improves Oncological Outcomes and Long-Term Survival Among Elderly Patients with Locally Advanced Gastric Cancer: A Propensity Score Matched Analysis

Authors: Karol Rawicz-Pruszyński, MD, Yutaka Endo, MD, Diamantis I. Tsilimigras, MD, Muhammad Musaab Munir, MD, Vivian Resende, MD, Alex Kim, MD, Joal Beane, MD, Zuzanna Pelc, MD, Katarzyna Sędłak, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)

Published in: Annals of Surgical Oncology | Issue 2/2024

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Abstract

Introduction

In the USA, approximately half of newly diagnosed patients with GC are 75 years or older. The objective of the current population-based study was to investigate the impact of neoadjuvant chemotherapy (NAC) on the outcomes of elderly patients with locally advanced GC.

Patients and Methods

Patients aged > 75 years were identified from the National Cancer Database (NCDB). The primary outcome of the study was overall survival (OS). Secondary outcomes included lymph node (LN) harvest, surgical margin status, and 30-day mortality. To minimize the effect of selection bias on the assessed outcome between the two study groups (NAC versus no NAC), propensity score matching (PSM) was performed.

Results

After PSM, a total of 1958 patients were included in both groups. NAC utilization increased from 2013 to 2019 (21% versus 42.7%, ptrend < 0.001). On pathologic analysis, patients who received NAC were more likely to have ≥ 16 LNs evaluated (NAC 60.1% versus no NAC 55.5%, p = 0.044) and negative resection margins (NAC 88.6% versus no NAC 83%, p = 0.001). Patients who received NAC were also less likely to experience 30-day mortality following resection (NAC 4.1% versus no NAC 7.1%). Receipt of NAC was associated with improved 1-year (73.9% versus 68.3%), 3-year (48.2% versus 43.5%), and 5-year OS (36.9% versus 30.5%) compared with patients who underwent upfront surgery (p = 0.01).

Conclusions

Receipt of NAC was associated with improved oncological outcomes among elderly patients undergoing resection for locally advanced GC.
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Literature
5.
go back to reference Society AC. Key Statistics About Stomach Cancer. 2022; Society AC. Key Statistics About Stomach Cancer. 2022;
14.
go back to reference Al-Batran S-E, Homann N, Schmalenberg H, et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial. Journal of Clinical Oncology. 2017;35(15_suppl):4004-4004. https://doi.org/10.1200/JCO.2017.35.15_suppl.4004 Al-Batran S-E, Homann N, Schmalenberg H, et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial. Journal of Clinical Oncology. 2017;35(15_suppl):4004-4004. https://​doi.​org/​10.​1200/​JCO.​2017.​35.​15_​suppl.​4004
15.
go back to reference Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://doi.org/10.1016/S0140-6736(18)32557-1.CrossRefPubMed Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948–57. https://​doi.​org/​10.​1016/​S0140-6736(18)32557-1.CrossRefPubMed
19.
go back to reference Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology. 3rd edn. Geneva: World Health Organization; 2000. Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology. 3rd edn. Geneva: World Health Organization; 2000.
20.
go back to reference Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. https://doi.org/10.3322/caac.21388 Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. https://​doi.​org/​10.​3322/​caac.​21388
Metadata
Title
Neoadjuvant Chemotherapy Improves Oncological Outcomes and Long-Term Survival Among Elderly Patients with Locally Advanced Gastric Cancer: A Propensity Score Matched Analysis
Authors
Karol Rawicz-Pruszyński, MD
Yutaka Endo, MD
Diamantis I. Tsilimigras, MD
Muhammad Musaab Munir, MD
Vivian Resende, MD
Alex Kim, MD
Joal Beane, MD
Zuzanna Pelc, MD
Katarzyna Sędłak, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.)
Publication date
20-11-2023
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 2/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14569-y

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