Lin L, Zhang P, Wang YY, Cai YF, Wen LB, Chen WP, Xiao YF, Li ZK, Liu GY. Early vs conventional initiation of adjuvant chemotherapy in advanced gastric cancer: A propensity-matched outcomes study. World J Gastroenterol 2025; 31(42): 110069 [PMID: 41278157 DOI: 10.3748/wjg.v31.i42.110069]
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08228836
Submitted on:
November 17, 2025, 16:57
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Reader Comments:
The study by Li Lin et al., “Early vs conventional initiation of adjuvant chemotherapy in advanced gastric cancer: A propensity-matched outcomes study,” addresses a clinically relevant question; however, several issues limit the strength and applicability of its conclusions.
First, the analysis does not demonstrate any clear advantage of early versus conventional initiation of adjuvant chemotherapy in terms of either overall survival or disease-free survival. A possible benefit is suggested with respect to the rate of peritoneal recurrence, but this signal is difficult to interpret in the absence of any comparison with currently available intraperitoneal treatment strategies.
Moreover, the study does not provide robust selection criteria to clearly identify which patients might be optimal candidates for an earlier initiation of adjuvant therapy. Given the well-known short-term physiological impact of gastrectomy, there is a concrete risk that patients starting chemotherapy very early after surgery may actually receive a suboptimal treatment—most notably through dose reductions—precisely in the first cycles, when dose intensity may be most critical.
Finally, the heterogeneity of the adjuvant chemotherapy regimens, which persists even after propensity score matching, further complicates interpretation of the results and limits the ability to draw firm conclusions regarding the true effect of treatment timing per se.