Abstract 454P
Background
Radical gastrectomy & D2 lymphadenectomy (RGD2) and perioperative chemotherapy are essential components of the multimodal approach in the management of early gastric cancer. There is a critical unmet need to delineate parameters that accurately predict survival post-RGD2 in low-middle-income countries, where patients at presentation have an advanced stage & higher symptom burden.
Methods
A consecutive series of patients who had undergone RGD2 at our hospital between Jan'17 - Dec'22 were included in this prospective analysis. The primary objective was overall survival (OS). Secondary objectives were event-free survival (EFS) (defined as local/distant recurrence, death, & being "lost to follow-up" for >18m since the last follow-up), pathological complete response (pCR) and relative safety, tolerability of planned neoadjuvant (NACT) & adjuvant chemotherapy (ACT). Compliance with planned chemotherapy (CPCT) is defined as 6 - 8 cycles of FLOT/CAPEOX or 5 - 6 cycles of EOX/DOX/CIS-5FU as NACT/ACT delivered at the discretion of the treating physician.
Results
A total of 207 patients had undergone RGD2 in the study period. The mean age of the cohort is 57.3 years. At a median follow-up period of 45.8m, OS for the analyzed cohort was 38.8m (CI 28.3 - 49.2), and EFS was 28m (CI 20.1 - 36.0). In Cox-multivariate analyses, factors associated with improved OS were an early pathological stage, uninvolved surgical margins & CPCT (Table). Post NACT pCR was 12.1% (20.5% for FLOT). Grade 3/4 toxicities & weight loss were noted similarly among those receiving NACT & ACT. Table: 454P
Cox proportional hazards regression modeling for EFS & OS, with factors noted significant (P<0.05) in univariate analyses
| Factor assessed | HR - EFS | p-value (sig p < 0.05) | HR - OS | p-value (sig p < 0.05) |
| Margin uninvolved | 0.38 (CI 0.18 – 0.81) | 0.013 | 0.42 (CI 0.19 – 0.91) | 0.028 |
| CPCT - yes | 0.53 (0.33 – 0.83) | 0.007 | 0.54 (0.32 – 0.93) | 0.026 |
| PNI + | 1.80 (1.11 – 2.93) | 0.016 | 1.53 (0.86 – 2.70) | 0.14 |
| LVI + | 1.45 (0.78 – 2.69) | 0.22 | 1.04 (0.52 – 2.10) | 0.90 |
| Early pathological stage | 0.51 (0.29 – 0.88) | 0.016 | 0.30 (0.16 – 0.58) | 0.000 |
| Node-Positive | 0.76 (0.39 – 1.49) | 0.43 | 0.74 (0.34 – 1.59) | 0.45 |
| Early T stage | 1.07 (0.67 – 1.71) | 0.75 | 1.15 (0.67 – 1.99) | 0.60 |
| Received NACT | 0.88 (0.58 – 1.33) | 0.56 | 0.98 (0.61 – 1.57) | 0.93 |
| Received ACT | 0.66 (0.39 – 1.12) | 0.13 | 0.71 (0.39 – 1.30) | 0.27 |
| Well Differentiated | 0.69 (0.36 – 1.34) | 0.28 | 0.24 (0.05 – 1.02) | 0.054 |
Conclusions
In addition to adverse pathological features (involved margin and advanced stage), non-compliance with the planned perioperative chemotherapy negatively impacted the survival post-RGD2.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.