Perioperative chemotherapy versus upfront surgery with adjuvant chemotherapy in gastric and esophagogastric junction adenocarcinoma, a retrospective trial

• DOI: 10.22533/at.ed.15931523060310

• Palavras-chave: -

• Keywords: gastric cancer, esophagogastric cancer, perioperative chemotherapy, adjuvant chemotherapy.

• Abstract:

  : gastric cancer represents a common cause of cancer death worldwide. Adenocarcinoma accounts for more than 95% of all gastric malignancies. Multimodal approaches in the treatment of localized gastric cancer have changed the natural history of the disease. Compared with surgery alone, several therapeutic approaches including perioperative chemotherapy or adjuvant chemotherapy improve survival. This study aimed to compare perioperative chemotherapy and upfront surgery with adjuvant chemotherapy in gastric and esophagogastric junction adenocarcinoma, in terms of clinical features, survival outcomes and prognostic factors.

  Methods: retrospective, single-center study, whose data were collected from electronic medical records by three investigators. Patients aged 18 years or older, treated in the public health system, between January 1^st, 2015 and December 31^st, 2020, diagnosed with gastric or esophagogastric junction adenocarcinoma Siewert 2 or 3, with cT2-4 or cN + (M0) staging were included. OS and PFS curves were developed according to the Kaplan-Meier method and they were compared using the log-rank test.

  Results: in terms of locoregional and distant recurrence, no statistically significant differences were found between the groups, HR 0.35 [IC 95% 0.09 – 1.34 p: 0.1137] and HR 1.02 [IC 95% 0.36 – 2.88 p:0,9683], respectively. In the analysis of overall survival, no statistically significant difference was observed, HR 0.71 [IC 95% 0.26 – 1.94 p: 0.5089].

  Conclusion: in this study, statistically significant differences were not observed for PFS and OS in the treatment of patients with localized gastric cancer regarding the use of perioperative chemotherapy versus upfront surgery with adjuvant chemotherapy. In the last decade, there has been a drive towards improving perioperative treatment strategies. Future directions with the incorporation of targeted therapy, immunotherapy, and ctDNA analysis will likely consolidate the perioperative treatment strategy as standard.