Early vs conventional initiation of adjuvant chemotherapy in advanced gastric cancer: A propensity-matched outcomes study

doi:10.3748/wjg.v31.i42.110069

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Nov 14, 2025; 31(42): 110069
Published online Nov 14, 2025. doi: 10.3748/wjg.v31.i42.110069

Early vs conventional initiation of adjuvant chemotherapy in advanced gastric cancer: A propensity-matched outcomes study

Li Lin, Peng Zhang, Ya-Yue Wang, Yi-Fan Cai, Li-Bing Wen, Wei-Ping Chen, Yi-Fan Xiao, Zhi-Kun Li, Guo-Yan Liu

Li Lin, Guo-Yan Liu, Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361102, Fujian Province, China

Li Lin, Guo-Yan Liu, Department of Gastrointestinal Surgery, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361102, Fujian Province, China

Peng Zhang, Li-Bing Wen, Wei-Ping Chen, School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, Fujian Province, China

Ya-Yue Wang, Yi-Fan Cai, Yi-Fan Xiao, Zhi-Kun Li, Guo-Yan Liu, School of Medicine, Xiamen University, Xiamen 361001, Fujian Province, China

Co-first authors: Li Lin and Peng Zhang.

Author contributions: Lin L, Wang YY, Cai YF, Wen LB, and Chen WP contributed to the writing - review & editing; Lin L, Zhang P, Wen LB, Chen WP, Xiao YF, and Li ZK participated in the methodology of the manuscript; Lin L and Zhang P were involved in the data curation; Lin L, Zhang P, Wen LB, Chen WP, and Liu GY contributed to the conceptualization; Lin L and Liu GY were major in the project administration; Lin L, Zhang P, Wang YY, Cai YF, Wen LB, Chen WP, Xiao YF, and Li ZK participated in the formal analysis; Zhang P contributed to the investigation, writing - original draft, and visualization; Wang YY, Cai YF, Wen LB, Chen WP, Xiao YF, and Li ZK were response to the validation; Liu GY took part in the supervision and resources. Lin L and Zhang P contributed equally to the manuscript and are co-first authors.

Supported by Xiamen Natural Science Foundation of China, No. 3502Z20227347.

Institutional review board statement: This research was carried out following the Declaration of Helsinki and received approval from the Ethics Committee of Zhongshan Hospital of Xiamen University (approval No. 2024-174).

Informed consent statement: Given the retrospective design of this investigation, the Ethics Committee of Zhongshan Hospital of Xiamen University granted us an exemption from obtaining written informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data included in this study can be obtained from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Guo-Yan Liu, MD, PhD, Professor, Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, No. 209 Hubin South Road, Siming District, Xiamen 361102, Fujian Province, China. liuguoyan@xmu.edu.cn

Received: May 29, 2025
Revised: July 12, 2025
Accepted: October 9, 2025
Published online: November 14, 2025
Processing time: 168 Days and 19 Hours

Abstract

BACKGROUND

Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy (AC) initiation, the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.

AIM

To evaluate the feasibility, safety, and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.

METHODS

In this retrospective cohort study, 219 stage II/III gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed. Patients were stratified by AC initiation timing: Early (10-13 days, n = 21) vs conventional (4-6 weeks, n = 198). Propensity score matching (1:2) was performed, with balance assessed via standardized mean differences. Recurrence-free survival, overall survival, and safety were compared between the two groups. Sensitivity analyses were conducted to assess the robustness of the findings.

RESULTS

After 1:2 matching (21 patients vs 42 patients), early AC demonstrated comparable 3-year recurrence-free survival (53.7% vs 61.6%, hazard ratio = 0.89, P = 0.562) and overall survival (69.1% vs 66.3%, P = 0.874) rates to conventional timing. Peritoneal recurrence was significantly lower in the early group (4.8% vs 26.2%, P = 0.048), although Cox regression did not confirm a significant difference (hazard ratio = 0.418, P = 0.257). Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions (57.1% vs 26.2%, P = 0.026) but similar grade 3/4 toxicity (42.9% vs 57.1%, P = 0.285).

CONCLUSION

Early AC initiation appears feasible in selected patients but necessitates individualized dose management. Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.

Keywords: Gastric cancer; Adjuvant chemotherapy; Postoperative timing; Survival rate; Propensity score; Recurrence pattern

Core Tip: This study pioneers the evaluation of adjuvant chemotherapy initiated within 10-13 days postgastrectomy under enhanced recovery protocols. Early initiation shows comparable survival outcomes to conventional timing but requires tailored dosing to mitigate toxicity. These findings suggest that early chemotherapy is both feasible and safe when carefully managed, and they emphasize the importance of integrating surgical recovery with oncologic treatment, offering a paradigm shift in personalized gastric cancer management.