2254 - Impact of Neoadjuvant Chemotherapy vs. Chemoradiotherapy on Postoperative Complications and Surgical Outcomes in Locally Advanced Gastric Cancer: A Propensity Score-Matched Study
Presenter(s)
Y. Wang1, X. Qiao2, Q. Liu1, Y. Song3, H. Fang3,4, B. Chen5, N. Lu2,3, S. Qi6, H. Jing3,7, S. Wang3,7, Y. LI3, Y. Tang3, N. Li7,8, and J. Jin3,9; 1Peking Union Medical College; The Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing, chaoyang, China, 2State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (PUMC), Beijing, China, 3State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China, 4Department of Radiation Oncology, National Cancer Canter/National Clinical Research /Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Bejing, China, 5Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China, 6National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China, 7Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 8Department of Radiobiology, Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China, 9Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
Purpose/Objective(s):
Neoadjuvant therapy can improve the R0 resection rate and pathological response in patients with locally advanced gastric cancer (LAGC); however, its impact on surgical safety remains controversial. This retrospective study aimed to compare postoperative complication rates between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT), identify independent risk factors for postoperative complications, and further evaluate differences in perioperative outcomes between the two treatment strategies.Materials/Methods:
This retrospective single-center study included patients with locally advanced gastric cancer (LAGC) who underwent neoadjuvant therapy followed by curative gastrectomy between January 2018 and December 2023. The study population comprised patients who received four cycles of SOX or XELOX chemotherapy combined with radiotherapy, with a contemporaneous cohort of patients receiving SOX/XELOX neoadjuvant chemotherapy (nCT) alone serving as the control. After propensity score matching (PSM), a total of 99 patients with clinical stage cT2–4N+M0 gastric adenocarcinoma were included, of whom 74 received neoadjuvant chemotherapy alone and 25 underwent induction chemotherapy followed by concurrent chemoradiotherapy (nCRT). The primary outcomes were postoperative complications and pathological response, with further analyses incorporating patient characteristics, surgery-related factors, and tumor-related variables.Results:
After propensity score matching, the most common postoperative complications were metabolic and nutritional disorders (18.2%) and infections (13.1%).There was no significant difference in overall postoperative complication rates between the nCRT and nCT groups (P = 0.952), nor in the incidence of severe complications (Clavien–Dindo grade =3a, P >0.999). No independent risk factors for postoperative complications were identified among the analyzed variables. Regarding perioperative outcomes, the nCRT group demonstrated significantly better pathological responses than the nCT group, with higher rates of pathological complete response (pCR) and favorable tumor regression grade (TRG1–2) (36.0% vs. 8.1% and 60.0% vs. 27.0%, respectively; P=0.002 and P=0.020).No significant differences were observed between the two groups in other perioperative outcomes.Conclusion:
Compared with neoadjuvant chemotherapy alone, neoadjuvant chemoradiotherapy did not increase the incidence of postoperative complications and showed significant advantages in improving the pathological complete response rate and the rate of adhesion-free surgery.