Table_1_Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer.docx

BackgroundThe relationship between time to surgery (TTS) and survival benefit is not sufficiently demonstrated by previous studies in locally advanced gastric cancer (LAGC). This study aims to assess the impact of TTS after neoadjuvant chemotherapy (NACT) on long-term and short-term outcomes in LAGC patients.
MethodsData were collected from patients with LAGC who underwent NACT between January 2007 and January 2018 at our institution. Outcomes assessed were long-term survival, pathologic complete response (pCR) rate, and postoperative complications.
ResultsThis cohort of 426 patients was divided into five groups by weeks of TTS. Under cox regression, compared to other groups, the 22–28 days and 29–35 days groups revealed a better OS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.185; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.004; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.022) and PFS (≤21 vs. 22–28 days: HR 1.54, 95% CI = 0.81–2.93, P = 0.256; 36–42 vs. 22–28 days: HR 2.20, 95% CI = 1.28−3.79, P = 0.111; 43–84 vs. 22–28 days: HR 1.83, 95% CI = 1.09–3.06, P = 0.047). Further analysis revealed a better prognosis in patients with TTS within 22–35 days (OS: HR 1.78 95% CI = 1.25−2.54, P = 0.001; PFS: HR 1.49, 95% CI = 1.07−2.08, P = 0.017). Postoperative stay was significantly higher in the ≤21 days group, while other parameters revealed no statistical significance (P > 0.05). Restricted cubic spline depicted the nonlinear relationship between TTS and OS/PFS.
ConclusionPatients who received surgery within 3−5 weeks experienced the maximal survival benefit without an increase in postoperative complications or lowering the rate of pCR. Further investigations are warranted.

【背景】既往研究尚未充分阐明局部进展期胃癌（locally advanced gastric cancer, LAGC）患者的手术间隔时间（time to surgery, TTS）与生存获益之间的关联。本研究旨在评估新辅助化疗（neoadjuvant chemotherapy, NACT）后的手术间隔时间对局部进展期胃癌患者短期及长期转归的影响。
【方法】本研究纳入2007年1月至2018年1月于本院接受新辅助化疗的局部进展期胃癌患者，收集其临床数据。本次研究评估的转归指标包括长期生存情况、病理完全缓解（pathologic complete response, pCR）率以及术后并发症发生情况。
【结果】本队列共纳入426例患者，按手术间隔时间以周为间隔分为5组。Cox回归分析结果显示，相较于其余各组，22~28天组与29~35天组的总生存期（Overall Survival, OS）更优：≤21天组 vs 22~28天组：风险比（Hazard Ratio, HR）1.54，95%置信区间（Confidence Interval, CI）0.81–2.93，P = 0.185；36~42天组 vs 22~28天组：HR 2.20，95%CI 1.28−3.79，P = 0.004；43~84天组 vs 22~28天组：HR 1.83，95%CI 1.09–3.06，P = 0.022。同时该两组的无进展生存期（Progression-Free Survival, PFS）亦更优：≤21天组 vs 22~28天组：HR 1.54，95%CI 0.81–2.93，P = 0.256；36~42天组 vs 22~28天组：HR 2.20，95%CI 1.28−3.79，P = 0.111；43~84天组 vs 22~28天组：HR 1.83，95%CI 1.09–3.06，P = 0.047。进一步分析显示，手术间隔时间处于22~35天区间的患者预后更佳（OS：HR 1.78，95%CI 1.25−2.54，P = 0.001；PFS：HR 1.49，95%CI 1.07−2.08，P = 0.017）。≤21天组的术后住院时长显著更长，其余各项指标均无统计学差异（P > 0.05）。限制性立方样条曲线显示手术间隔时间与总生存期、无进展生存期之间存在非线性关联。
【结论】于新辅助化疗后3~5周内接受手术的患者可获得最优生存获益，且未出现术后并发症发生率升高或病理完全缓解率降低的情况。未来仍需开展进一步研究加以验证。