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Upper GI

Upper GI Parallel Session

89: Survival Outcomes in Patients with Resectable Gastric Cancer Treated with Total Neoadjuvant Therapy

Friday, March 22, 2024
10:32am – 10:42am ET
Location: C102
Disclosure(s):
Yun Song, MD: No financial relationships to disclose
Brian Badgwell, MD, MS: No financial relationships to disclose
Introduction: Perioperative chemotherapy is the standard of care for patients with advanced gastric cancer. Total neoadjuvant therapy (TNT), which includes both chemotherapy and chemoradiation, is increasingly utilized in other malignancies. The purpose of this study is to determine overall survival (OS) in a contemporary cohort of gastric cancer patients treated with TNT.  


Methods: Patients diagnosed with microsatellite-stable clinical T2+ or N+ gastric adenocarcinoma (1/2012-6/2022) were identified from a prospectively maintained institutional database. Those who underwent staging laparoscopy and received neoadjuvant chemotherapy and chemoradiation, followed by gastrectomy, were included in the study. OS and variables associated with OS were determined using standard statistical methods.


Results: Of 203 patients, the median (interquartile range) age was 61 (50-69.5) years and 50 (24.6%) had tumor involving the gastroesophageal junction. The most common TNT sequence was induction chemotherapy followed by chemoradiation (N=173 [85.2%]). The chemotherapy regimen typically given was fluorouracil and oxaliplatin (N=149 [73.4%]). The most common radiation dose was 45 Gy in 25 fractions (N=169 [83.3%] patients). One hundred ninety-seven (97.0%) patients completed all planned neoadjuvant therapy. Surgical resection included total gastrectomy in 108 (53.2%), adjacent organ resection in 24 (11.8%), and extended (D1+/D2) lymphadenectomy in 193 (95.1%) patients. Pathologic complete response (pCR) was achieved in 32 (15.8%) patients. The median OS was 8.4 (95% confidence interval [CI] 6.5-not reached) years, and the 5-year OS rate was 65.2% (95% CI 57.8-73.5%). Patients with pCR had a 5-year OS rate of 89.1% (95% CI 78.1-100.0%). On multivariable analysis, D1+/D2 lymphadenectomy (HR 0.21 [95% CI 0.088-0.51]), post-treatment pathologic (yp) T (ypT3 vs ypT0, HR 3.11 [95% CI 1.09-8.82]; ypT4 vs ypT0, HR 5.51 [95% CI 1.64-18.5]) and N stages (ypN1 vs ypN0, HR 2.41 [95% CI 1.13-5.13]; ypN2 vs ypN0, HR 2.43 [95% CI 1.14-5.20]; ypN3 vs ypN0, HR 4.70 [95% CI 2.09-10.6]), incidental distant metastasis at time of resection (HR 3.75 [95% CI 1.50-9.37]), and postoperative complications (HR 2.06 [95% CI 1.21-3.52]) were associated with OS.


Conclusions: TNT is associated with a high rate of treatment completion and promising long-term OS for patients with resectable gastric cancer. Comparative studies with perioperative treatment and predictors of tumor response will be important in identifying patients suitable for TNT.

Learning Objectives:

  • Describe overall survival outcomes following total neoadjuvant therapy for patients with resectable gastric cancer.
  • Identify factors associated with improved overall survival following total neoadjuvant therapy for gastric cancer.
  • List the advantages of providing neoadjuvant therapy in advanced gastric cancer.