Rationale for Neoadjuvant Chemotherapy for Advanced Gastric Cancer

Abstract

The recent clinical outcome of treatment for early-stage gastric cancer is excellent in Japan; the 5 year survival rate is more than 90% in patients with stage I disease and 70% in patients with stage II disease. The prognosis of patients with advanced disease (e.g., stage III or IV) remains poor even after complete surgical resection. With such advanced disease, the survival benefit from conventional strategies such as extended surgery with or without postoperative chemotherapy is likely to be limited in consideration of the disappointing results obtained with postoperative adjuvant chemotherapy. A meta-analysis performed by Hermans et al., which analyzed 14 prospective randomized adjuvant trials including 2096 patients, has failed to reveal a consistent beneficiai effect [1].The analysis was later repeated and published in a letter to the editor in response to suggestions that additional trials should be included [2]. The final odds ratio decreased from 0.88 to 0.67, indicating a possible survival benefit from adjuvant chemotherapy. Although encouraging, it is clear that more definitive trials are necessary to test the efficacy of postoperative adjuvant chemotherapy for high-risk patients.