Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2020; 26(8): 818-827
Published online Feb 28, 2020. doi: 10.3748/wjg.v26.i8.818
Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study
Yang Li, Fu-Hai Ma, Li-Yan Xue, Yan-Tao Tian
Yang Li, Fu-Hai Ma, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Li Y and Ma FH contributed equally to this work and they were involved in study concept, data acquisition, analysis, and interpretation, and production of tables, wrote the first draft, and revised it critically in light of comments from other authors; Tian YT and Xue LY were involved in study conception and design, data interpretation, manuscript revision, and discussion; all authors approved the final version submitted.
Supported by National Natural Science Foundation of China, No. 81772642; Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022.
Institutional review board statement: This study was approved by the institutional review board of the National Cancer Center of China.
Informed consent statement: The institutional review board waived informed consent due to the retrospective nature of this research.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Beijing 100021, China. tyt67@163.com
Received: January 13, 2020
Peer-review started: January 13, 2020
First decision: January 16, 2020
Revised: January 20, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: February 28, 2020
Processing time: 45 Days and 19 Hours
ARTICLE HIGHLIGHTS
Research background

Some studies have investigated the benefit of neoadjuvant chemotherapy (NAC) in gastric signet-ring cell carcinoma (SRCC). However, the results are inconsistent. Earlier research showed that NAC was associated with better outcomes, though the response to NAC was relatively weak in gastric SRCC. The benefit of NAC for patients with SRCC of the stomach is controversial.

Research motivation

Earlier research showed that NAC was associated with better outcomes, though the response to NAC was relatively weak in gastric SRCC. Conversely, other studies suggested that NAC provided no survival benefit in patients with gastric SRCC. Moreover, some studies found that NAC is an independent predictor of poor survival because of its toxicity. We conducted a single-center, large-scale retrospective study to determine if there are benefits of NAC for treating gastric SRCC.

Research objectives

This study aimed to evaluate the perioperative and long-term outcomes of NAC for locally advanced gastric SRCC.

Research methods

This study identified patients with locally advanced SRCCs of the stomach diagnosed by using the clinical Tumor-Node-Metastasis staging system. The histologic and prognostic effects of NAC were assessed. The overall survival rates were used as the outcome measure to compare the efficacy of NAC vs surgery-first treatment in the selected patients.

Research results

The R0 resection rates were 88.9% and 86.1% in the surgery-first and NAC groups after propensity score matching (PSM), respectively. The median follow-up period was 46.4 mo. The 5-year overall survival rates of the NAC group and surgery-first group were 50.0% and 65.0%, before PSM and 50% and 64.7% after PSM.

Research conclusions

NAC provides no survival benefit in patients with locally advanced gastric SRCC. And, for resectable gastric SRCC, upfront surgery should be the primary therapy.

Research perspectives

Future studies that better stratify the SRCC components are warranted.