Background/Objectives: Neo-adjuvant chemotherapy (NACT) is increasingly utilized in Western countries for the treatment of gastric cancer (GC). While its oncologic benefits are well established, its impact on surgical safety and long-term outcomes remain a matter of debate. This study evaluates the real-world effect of NACT on perioperative and oncologic outcomes in a high-volume Western center.Methods:Data from 254 patients who underwent gastrectomy with D2 lymphadenectomy for GC between March 2016 and January 2024 were prospectively collected and retrospectively analyzed. Patients were categorized into an upfront surgery group (n = 144, 56.7%) and a NACT group (n = 110, 43.3%). The primary outcome was to compare the two study groups in terms of perioperative outcomes, as well as overall (OS) and disease-free survival (DFS). Multivariate analyses were conducted to identify factors associated with perioperative complications and long-term survival.Results:Patients in the NACT group were younger (median age 65 vs. 72 years;p= 0.001) and had fewer comorbidities. NACT was associated with a higher incidence of proximal tumors (54–49.1% vs. 37–25.7%;p= 0.001), diffuse-type tumors (27–45.8% vs. 39–31.7%;p= 0.03), and lymph-node metastases (82–74.1% vs. 84–58%;p= 0.007). No significant differences were observed in median hospital stay (9 (7–16) and 10 (8–22) days for the upfront and NACT groups, respectively;p= 0.26), post-operative mortality (11–7.6% and 5–4.5% for the upfront and NACT groups, respectively;p= 0.32), and major complications (30–20.8% and 23–20.9% for the upfront and NACT groups, respectively;p= 0.99). Among patients receiving NACT, the FLOT regimen was associated with a lower rate of complications (12–16.2% vs. 11–30.5% in the non-FLOT cohort;p= 0.05) and reoperations (4–5.4% vs. 8–22.2% in the non-FLOT group;p= 0.008). Tumor location was identified as an independent predictor of perioperative complications (OR 4.7, 95% C.I.: 1.56–14.18;p= 0.006), while non-FLOT regimens were independently associated with higher reoperation rates (OR 0.22, 95% C.I.: 0.06–0.86;p= 0.003). Five-year OS was comparable between the two groups (44.6% in the NACT group vs. 47.7% in the upfront surgery group;p= 0.96). N+ status (OR 2.5, 95% C.I. 1.42–4.40;p= 0.001) and R+ margins (OR 1.89, 95% C.I. 0.98–3.65;p= 0.006) were negative independent prognostic factors for DFS.Conclusions:Although several selection biases limit the generalizability of our findings, our results suggest that NACT prior to gastrectomy for GC does not increase postoperative morbidity and mortality in appropriately selected patients. However, its use in elderly and polymorbid patients should be carefully considered to determine the safest and most effective therapeutic approach, particularly in selecting the appropriate chemotherapy regimen, to minimize the risk of postoperative complications requiring surgical reintervention.
背景/目的：新辅助化疗（NACT）在西方国家越来越多地用于胃癌（GC）的治疗。虽然其肿瘤学获益已得到公认，但其对手术安全性和长期结局的影响仍存在争议。本研究评估了在一个高手术量的西方中心，NACT对围手术期和肿瘤学结局的真实世界影响。 方法：前瞻性收集并回顾性分析了2016年3月至2024年1月期间接受胃癌根治术（胃切除术联合D2淋巴结清扫术）的254例患者数据。患者被分为直接手术组（n = 144，56.7%）和NACT组（n = 110，43.3%）。主要结局是比较两组在围手术期结局、总生存期（OS）和无病生存期（DFS）方面的差异。进行多变量分析以确定与围手术期并发症和长期生存相关的因素。 结果：NACT组患者更年轻（中位年龄65岁 vs. 72岁；p=0.001），合并症更少。NACT与近端肿瘤（54例–49.1% vs. 37例–25.7%；p=0.001）、弥漫型肿瘤（27例–45.8% vs. 39例–31.7%；p=0.03）和淋巴结转移（82例–74.1% vs. 84例–58%；p=0.007）的发生率较高相关。在中位住院时间（直接手术组和NACT组分别为9（7-16）天和10（8-22）天；p=0.26）、术后死亡率（直接手术组和NACT组分别为11例–7.6%和5例–4.5%；p=0.32）以及主要并发症（直接手术组和NACT组分别为30例–20.8%和23例–20.9%；p=0.99）方面，未观察到显著差异。在接受NACT的患者中，FLOT方案与较低的并发症发生率（12例–16.2% vs. 非FLOT队列的11例–30.5%；p=0.05）和再手术率（4例–5.4% vs. 非FLOT组的8例–22.2%；p=0.008）相关。肿瘤位置被确定为围手术期并发症的独立预测因素（OR 4.7，95% C.I.：1.56–14.18；p=0.006），而非FLOT方案与较高的再手术率独立相关（OR 0.22，95% C.I.：0.06–0.86；p=0.003）。两组患者的五年OS相当（NACT组44.6% vs. 直接手术组47.7%；p=0.96）。淋巴结阳性状态（OR 2.5，95% C.I. 1.42–4.40；p=0.001）和切缘阳性（OR 1.89，95% C.I. 0.98–3.65；p=0.006）是DFS的负面独立预后因素。 结论：尽管一些选择偏倚限制了我们研究结果的普适性，但我们的结果表明，对于经过适当选择的患者，胃癌胃切除术前的NACT并不会增加术后发病率和死亡率。然而，在老年和合并多种疾病的患者中使用NACT应谨慎考虑，以确定最安全有效的治疗方法，特别是在选择合适的化疗方案时，以最大限度地降低需要再次手术干预的术后并发症风险。
肿瘤(癌症)患者之家