Neoadjuvant chemotherapy or adjuvant chemotherapy is similarly beneficial for five-year overall survival in locally advanced gastric cancer patients

Abstract Background: Different types of neoadjuvant chemotherapy regimens have been compared for gastric cancer, mostly in terms of radiological downgrading or pathological tumor regression; however, no large-scale multicenter randomized controlled trial (RCT) has conducted a head-to-head comparison of the overall survival rate between perioperative or neoadjuvant chemotherapy(NAC) and postoperative or adjuvant chemotherapy(AC). We explored whether the five-year overall survival rate was greater in patients who received perioperative chemotherapy plus surgery than in those who underwent surgery first and then underwent postoperative chemotherapy. Methods: Altogether, 77 patients with a clinical diagnosis of cTNM stage III were included. Five-year overall survival (OS) rates were compared between patients who underwent neoadjuvant chemotherapy plus surgery (NAC) and those who underwent surgery first plus adjuvant chemotherapy (AC). Propensity score matching was used to adjust for disparity between the two groups. A Kaplan-Meier plot was created for survival analysis, and the log-rank method was used to compare the differences in OS. Results: A total of 34 patients were in the NAC and 43 patients were in the AC group, respectively. There was no significant difference in age (median, 64 vs. 66 years), cTNM staging, or extent of gastrectomy between the two groups (p<0.05). The median follow-up time was 58 months (range: 53-65 months). The five-year overall survival (OS) rates for patients in the NAC and AC groups were 61.8% and 73.5%, respectively. There was no significant difference between the two groups in the five-year overall survival rates (p>0.05). There was no significant difference in the severity of postoperative complications between the two groups (p>0.05). Conclusions: There was no significant difference in the five-year overall survival rate between patients who underwent perioperative chemotherapy plus surgery and those who underwent surgery plus postoperative chemotherapy alone. A well-controlled prospective study is necessary to confirm whether perioperative chemotherapy is superior to postoperative chemotherapy in patients with GC.