Neoadjuvant Therapies for Patients with Locally Advanced Gastric Cancer: A Retrospective Cohort Study

Gastric cancer is the second main cause of cancer-related deaths. Since the disease does not produce typical symptoms in the early periods, diagnosis is usually made in locally advanced stages. Although surgery is the most curative treatment, neoadjuvant chemotherapy (NACT) occupies a highly important place in prognosis.

Patients operated due to locally advanced gastric cancer (LAGC) in 2015-2022 were investigated retrospectively. These were divided into 2 groups, NACT+surgery+adjuvant chemotherapy (AC) (group 1) and surgery-ACT (group 2). The patients' clinicopathological characteristics and postoperative outcomes were compared. Overall survival (OS) and disease-free survival (DFS) analyses were also performed.

Eighty-four patients who underwent surgery following NACT and 60 resectable patients who underwent surgery and then received ACT were evaluated. The patients' mean age was 62.96 years, and 61.8% were men. Perineural and lymphovascular invasion, total lymph nodes removed, and numbers of metastatic lymph nodes were significantly higher in group 2 (P < .05). Postoperative complication rates were 22.6% in group I and 33.33% in group 2, the difference being statistically significant (P = .034). Recurrence and metastasis rates were higher in group 2. Patients in group 1 exhibited significantly longer OS and DFS than those in group 2 (P < .05).

Neoadjuvant chemotherapy has a positive impact on survival in LAGC patients. It also reduces recurrence and metastasis rates and postoperative complications. The most important factor affecting survival is the patient's receipt of NACT. Other factors affecting OS and DFS include metastatic lymph node numbers and lymphovascular invasion.