Does neoadjuvant chemotherapy cancel out the negative survival impact induced by surgical complications after gastrectomy?
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Postoperative infectious complications (ICs) are associated with a poor prognosis following gastric cancer surgery. Neoadjuvant chemotherapy (NAC) targeting scirrhous-type or bulky nodal disease reportedly exerts a prophylactic effect on the negative impact of ICs. However, a recent study clearly showed that NAC for scirrhous-type disease had no survival benefit. We investigated this prophylactic effect and significant interactions among subgroups of histological response, macroscopic type, and bulky nodal disease.
We examined 115 patients who received NAC followed by radical gastrectomy between January 2008 and December 2015. The overall survival (OS) and disease-free survival (DFS) were compared between those with and without ICs. Our cohort included 62 with type 4/giant type 3, 44 with bulky nodal disease/para-aortic nodal disease, and 25 with other diseases.
A histological response was observed in 80 patients (69.5%). Thirty three (28.7%) developed ICs. There was no significant difference in the OS [hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.47–1.99, p = 0.920] or DFS (HR 0.74; 95% CI 0.40–1.38, p = 0.342) by the presence of ICs. The HR was 1.00 in patients who had no response to NAC (grade 0/1a) and 0.95 in those who responded to NAC (grade 1b/2/3). No subgroups showed significant interactions for the OS.
NAC may cancel out the negative impact of morbidity on the survival in advanced gastric cancer patients. The prophylactic effects by NAC do not depend on the tumor type or histological response.
KeywordsGastric cancer Neoadjuvant chemotherapy Infectious complication
This study was approved by an Ethical Committee of the National Cancer Center Hospital (No: 2017-077).
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest that are directly relevant to the content of this manuscript.
- 5.Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–41.Google Scholar
- 12.Matsuda S, Takeuchi H, Kawakubo H, Fukuda K, Nakamura R, Takahashi T, et al. Correlation between intense postoperative inflammatory response and survival of esophageal cancer patients who underwent transthoracic esophagectomy. Ann Surg Oncol. 2015;22(13):4453–60. https://doi.org/10.1245/s10434-015-4557-5 Epub 2015 Apr 18.CrossRefGoogle Scholar
- 14.Schuhmacher C, Gretschel S, Lordick F, Reichardt P, Hohenberger W, Eisenberger CF, et al. Neoadjuvant chemotherapy compared with surgery alone for locally advanced cancer of the stomach and cardia: european organisation for research and treatment of cancer randomized trial 40954. J Clin Oncol. 2010;28:5210–8.CrossRefGoogle Scholar
- 19.Iwasaki Y, Terashima M, Mizusawa J, Katayama H, Nakamura K, Katai H, et al. Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer: Japan clinical oncology group study (JCOG0501). J Clin Oncol. 2018;15(15_suppl):4046–4046. https://doi.org/10.1200/JCO.2018.36.15_suppl.4046 CrossRefGoogle Scholar
- 22.Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan clinical oncology group postoperative complications criteria. Surg Today. 2016;46(6):668–85. https://doi.org/10.1007/s00595-015-1236-x Epub 2015 Aug 20.CrossRefGoogle Scholar
- 24.Nakamura K, Kuwata T, Shimoda T, Mizusawa J, Katayama H, Kushima R, et al. Determination of the optimal cutoff percentage of residual tumors to define the pathological response rate for gastric cancer treated with preoperative therapy (JCOG1004-A). Gastric Cancer. 2015;18(3):597–604. https://doi.org/10.1007/s10120-014-0401-z Epub 2014 Jun 27.CrossRefGoogle Scholar
- 25.Tsuburaya A, Mizusawa J, Tanaka Y, Fukushima N, Nashimoto A, Sasako M, et al. Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis. Br J Surg. 2014;101(6):653–60. https://doi.org/10.1002/bjs.9484 Epub 2014 Mar 25.CrossRefGoogle Scholar