Impact of chemotherapy delay on long-term prognosis of laparoscopic radical surgery for locally advanced gastric cancer: a pooled analysis of four randomized controlled trials.
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引用次数: 0
Abstract
Background: Adjuvant chemotherapy following curative surgery for locally advanced gastric cancer (AGC) significantly improves long-term patient prognosis. However, delayed chemotherapy (DC), in which patients are unable to receive timely treatment, is a common phenomenon in clinical practice for various reasons. This study aimed to investigate the impact of DC on the prognosis of patients with stage II-III locally AGC and explore the associated risk factors.
Methods: Data from four prospective studies were included in the pooled analysis. The planned chemotherapy (PC) group was defined as the time interval between surgery and the first chemotherapy ≤ 49 d, while the DC group was defined as the time interval between surgery and chemotherapy > 49 d. The prognosis, recurrence, and risk factors were compared, and a nomogram for predicting DC was established.
Results: In total, 596 patients were included, of whom 531 (89.1%) had PC and 65 (10.9%) had DC. Survival analysis revealed that the 5-year overall survival (OS) and disease-free survival (DFS) were significantly lower in the DC group than those in the PC group (log-rank P < 0.001). Cox univariable and multivariable analyses showed that DC was an independent risk factor for OS and DFS in stage II-III patients (P < 0.05). Based on the significant factors for DC, a prediction model was established that had a good fit, high accuracy (AUC = 0.780), and clinical applicability in both the training and validation sets.
Conclusion: Delayed chemotherapy after gastrectomy is associated with poor long-term prognosis in patients with locally advanced stage II-III GC disease. But standardized, full-cycle adjuvant chemotherapy after surgery may play a remedial role, and can to a certain extent compensate the poor effects caused by delayed chemotherapy.
背景：局部晚期胃癌（AGC）根治性手术后的辅助化疗可显著改善患者的长期预后。然而，由于各种原因，患者无法及时接受化疗的延迟化疗（DC）现象在临床实践中十分常见。本研究旨在探讨延迟化疗对II-III期局部AGC患者预后的影响，并探讨相关风险因素：方法：将四项前瞻性研究的数据纳入汇总分析。计划化疗（PC）组的定义是手术与首次化疗之间的时间间隔≤49 d，而DC组的定义是手术与化疗之间的时间间隔大于49 d。比较了预后、复发和风险因素，并建立了预测DC的提名图：共纳入 596 例患者，其中 531 例（89.1%）为 PC 型，65 例（10.9%）为 DC 型。生存期分析显示，DC 组的 5 年总生存期（OS）和无病生存期（DFS）明显低于 PC 组（对数秩 P 结论：DC 组的 5 年总生存期和无病生存期明显低于 PC 组（对数秩 P 结论：DC 组的 5 年总生存期和无病生存期明显低于 PC 组）：胃切除术后延迟化疗与局部晚期II-III期GC患者的长期预后不良有关。但术后规范的全周期辅助化疗可起到补救作用，可在一定程度上弥补延迟化疗带来的不良后果。
期刊介绍：
Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide.
The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics.
Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field.
With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.
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