Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in...

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Autores principales:	Zining Liu, Yinkui Wang, Fei Shan, Xiangji Ying, Yan Zhang, Shuangxi Li, Yongning Jia, Rulin Miao, Kan Xue, Zhemin Li, Ziyu Li, Jiafu Ji
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	gastric cancer perioperative chemotherapy lymph node metastasis duration decision tree model Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/da783f24c9ff40ac9141530ec843d479
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spelling	oai:doaj.org-article:da783f24c9ff40ac9141530ec843d4792021-12-01T21:27:09ZDuration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved2234-943X10.3389/fonc.2021.775166https://doaj.org/article/da783f24c9ff40ac9141530ec843d4792021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.775166/fullhttps://doaj.org/toc/2234-943XBackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.Zining LiuYinkui WangFei ShanXiangji YingYan ZhangShuangxi LiYongning JiaRulin MiaoKan XueZhemin LiZiyu LiJiafu JiFrontiers Media S.A.articlegastric cancerperioperative chemotherapylymph node metastasisdurationdecision tree modelNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	gastric cancer perioperative chemotherapy lymph node metastasis duration decision tree model Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	gastric cancer perioperative chemotherapy lymph node metastasis duration decision tree model Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Zining Liu Yinkui Wang Fei Shan Xiangji Ying Yan Zhang Shuangxi Li Yongning Jia Rulin Miao Kan Xue Zhemin Li Ziyu Li Jiafu Ji Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
description	BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.
format	article
author	Zining Liu Yinkui Wang Fei Shan Xiangji Ying Yan Zhang Shuangxi Li Yongning Jia Rulin Miao Kan Xue Zhemin Li Ziyu Li Jiafu Ji
author_facet	Zining Liu Yinkui Wang Fei Shan Xiangji Ying Yan Zhang Shuangxi Li Yongning Jia Rulin Miao Kan Xue Zhemin Li Ziyu Li Jiafu Ji
author_sort	Zining Liu
title	Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
title_short	Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
title_full	Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
title_fullStr	Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
title_full_unstemmed	Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved
title_sort	duration of perioperative chemotherapy in locally advanced gastric cancer: a “less is more” question when ypn0 is achieved
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/da783f24c9ff40ac9141530ec843d479
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Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

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