Perioperative versus adjuvant chemotherapy in carcinoma stomach-A retrospective propensity-matched analysis.

Background: A uniform consensus on the optimal sequencing of treatment modalities in locally advanced gastric cancer is not reached due to conflicting results worldwide. We conducted a retrospective propensity-matched analysis to compare survival of locally advanced gastric cancer patients who were treated with peri-operative chemotherapy followed by surgery or upfront surgery followed by adjuvant chemotherapy.

Methods: Deidentified records of prospectively maintained data of locally advanced gastric cancer patients treated from 2015 to 2020 were collected. A 1:1 propensity matching with a tolerance limit of 0.2 was performed. The outcome variables including recurrence-free and overall survival were compared among the matched groups using log-rank tests and Cox proportional hazards analysis was performed.

Results: Two hundred patients (64 in peri-operative chemotherapy and 136 in the upfront surgery group) were included in the study. Variables including age group, sex, gastric outlet obstruction, tumor site, clinical T stage and node positivity were used for matching. The median overall survival and recurrence-free survival were found to be 21.90 months (95% CI = 13.30-30.49) and 15.08 months (95% CI = 8.17-21.98), respectively, in the peri-operative chemotherapy arm and 18.70 months (95% CI = 11.88-25.51) and 13.49 months (95% CI = 6.76-20.21), respectively, in upfront surgery arm with no significant difference (median follow-up 42 months). Patients who presented with pallor had Borrmann type 4 on endoscopy, received lesser number of chemotherapy cycles, lymph node ratio was > 0.13 and perineural invasion were associated with worse overall survival and recurrence-free survival.

Conclusion: In this real-world scenario, retrospective propensity-matched study, no difference was noted in overall survival and recurrence-free survival between patients who received peri-operative chemotherapy or upfront surgery followed by adjuvant chemotherapy in locally advanced gastric cancer.