Preoperative versus postoperative chemo-radiotherapy for locally advanced gastric cancer: a multicenter propensity score-matched analysis

Ning Li, Xiaoyong Xiang, Dongbin Zhao, Xin Wang, Yuan Tang, Yihebali Chi, Lin Yang, Liming Jiang, Jun Jiang, Jinming Shi, Wenyang Liu, Hui Fang, Yu Tang, Bo Chen, Ningning Lu, Hao Jing, Shunan Qi, Shulian Wang, Yueping Liu, Yongwen Song, Yexiong Li, Liyuan Zhang, Jing Jin, Ning Li, Xiaoyong Xiang, Dongbin Zhao, Xin Wang, Yuan Tang, Yihebali Chi, Lin Yang, Liming Jiang, Jun Jiang, Jinming Shi, Wenyang Liu, Hui Fang, Yu Tang, Bo Chen, Ningning Lu, Hao Jing, Shunan Qi, Shulian Wang, Yueping Liu, Yongwen Song, Yexiong Li, Liyuan Zhang, Jing Jin

Abstract

Background: Peri-operative chemo-radiotherapyplayed important rolein locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT).

Methods: From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups.

Results: The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p = 0.244), 78.7% vs. 65.7% (p = 0.017), 74.9% vs. 65.3% (p = 0.042) and 74.4% vs. 61.2% (p = 0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis.

Conclusion: Preoperative CRT showed advantages of oncologic outcome compared with postoperative CRT.

Trial registration: ClinicalTrial.gov NCT01291407 , NCT03427684 and NCT04062058 , date of registration: Feb 8, 2011.

Keywords: Gastric cancer; Long-term outcome; Postoperative chemo-radiotherapy; Preoperative chemo-radiotherapy.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan-Meier plots for disease-free survival (DFS) for entire cohort
Fig. 2
Fig. 2
Kaplan-Meier plots for disease-free survival (DFS) after PSM

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