Characteristic and clinical outcome of localized gastric cancer; real-world data

Gastric/gastroesophageal junction (GEJ) cancers have a poor prognosis even when present in earlier stages. Different treatment approaches have been studied to improve its outcome beyond surgery. This includes perioperative chemotherapy, neoadjuvant chemoradiotherapy, and adjuvant chemotherapy. This study aims to report patients' characteristics and treatment outcomes with localized/locally advanced gastric cancer.

This is a retrospective study of consecutive patients diagnosed with non-metastatic gastric and GEJ cancer and treated at a tertiary care center from January 2018 to September 2022. Demographics, clinical staging, chemotherapy data, surgical data and recurrence and follow up were recorded. The survival outcomes were estimated by Kaplan–Meier method, and variables associated with survival were compared by the Log-Rank test.

Sixty-eight patients (47 males, 69%) were eligible for this study. The median age at diagnosis was 56 (21-90) years. The primary site was the GEJ in 25 patients (36.8%), proximal in 11 (16.2%), and distal in 29 patients(42.6%). One patient had linitis plastica. The pathology was adenocarcinoma in all patients, intestinal type in 26 (38.2%), diffuse in 19 (27.9%), mixed in 5 patients (7.4%) and nonspecific in 18 patients (26.5%). Thirty-two patients (47.8%) had signet ring or mucinous histology. Seventeen patients (25%) were HER2 positive, and two had microsatellite instability. Clinical T stage was ≤ T3 in 53 patients (77.9%), T4 in 10 (14.7%), and Tx in 5 patients. Twenty patients (29.4%) had nodal involvement. ECOG performance status was 0/1 in 51 patients (75%), 2 in 8 (11.8%), 3 in 2 patients, and not available in 7 (10.3%). All patients have received at least three cycles of chemotherapy; however, three patients were treated with chemoradiotherapy as per CROSS protocol. Forty-seven patients were treated with the FLOT regimen, and 18 received FOLFOX/XELOX. The median number of preoperative chemotherapy cycles was five (range, 3-11). Eighteen patients completed their chemotherapy protocol before surgery (11 received 8 cycles FLOT, and 7 received at least 8 cycles XELOX/FOLFOX). Sixty-one patients underwent surgery, 29 (42.6%) with hyperthermic intraperitoneal chemotherapy, and 30 received intraoperative radiotherapy (IORT). Twenty-nine patients received postoperative chemotherapy with a median of 4 cycles (2-4). Twenty patients developed recurrence/progression. At a median follow-up of 23 months (15.2–37.0), the median progression-free survival (PFS) was 20 months, (95% CI, 8.5–31.5) and median overall survival was 35.0 months (95% CI 19.5-50.5).

Our real-world data showed less favorable outcome than reported in clinical trials. Subgroup analysis comparing neoadjuvant FLOT vs FOLFOX/XELOX, pre-operative vs. peri-operative strategy and the value of added HIPEC and IORT will be presented in the meeting.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.