Wu JW, Li F, Wang SD, Guo YK, Li BH, Zhou X, Su GQ, Lu CH. Prognostic factors and optimal timing for initiating adjuvant chemotherapy in stage IIIC gastric cancer. World J Gastrointest Oncol 2026; 18(7): 119040 [DOI: 10.4251/wjgo.v18.i7.119040]
Corresponding Author of This Article
Chuan-Hui Lu, Chief Physician, The Graduate School of Fujian Medical University, No. 1 Xuefu North Road, Shangjie Town, Minhou County, Fuzhou 350122, Fujian Province, China. 46601533@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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Wu JW, Li F, Wang SD, Guo YK, Li BH, Zhou X, Su GQ, Lu CH. Prognostic factors and optimal timing for initiating adjuvant chemotherapy in stage IIIC gastric cancer. World J Gastrointest Oncol 2026; 18(7): 119040 [DOI: 10.4251/wjgo.v18.i7.119040]
World J Gastrointest Oncol. Jul 15, 2026; 18(7): 119040 Published online Jul 15, 2026. doi: 10.4251/wjgo.v18.i7.119040
Prognostic factors and optimal timing for initiating adjuvant chemotherapy in stage IIIC gastric cancer
Jun-Wei Wu, Fan Li, Shi-Dian Wang, Yu-Kun Guo, Bing-Huang Li, Xin Zhou, Chuan-Hui Lu, Guo-Qiang Su
Jun-Wei Wu, Fan Li, Shi-Dian Wang, Yu-Kun Guo, Bing-Huang Li, Chuan-Hui Lu, The Graduate School of Fujian Medical University, Fuzhou 350122, Fujian Province, China
Jun-Wei Wu, Fan Li, Xin Zhou, Guo-Qiang Su, Chuan-Hui Lu, Department of Colorectal Cancer Surgery, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China
Co-first authors: Jun-Wei Wu and Fan Li.
Author contributions: Wu JW drafted the initial version of the paper; Li F was in charge of analyzing data as well as drawing the charts; Wu JW and Li F have made crucial and indispensable contributions towards the completion of the project, they contributed equally to this article, they are the co-first authors of this manuscript; Wang SD, Guo YK, and Li BH in charge of collecting data; Zhou X participated in the review and editing; Su GQ reviewed and revised the paper and acquired funding; Lu CH conceptualized and designed this study; and all of the authors read and approved the final version of the manuscript to be published.
Supported by National Natural Science Foundation of China, No. 81970462; and Key Medical and Health Project of Xiamen, No. 3502Z20204001.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Xiamen University, approval No. (2024) Scientific Research Ethics Review (014).
Informed consent statement: The patient signed the informed consent form.
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: For this study, the data supporting the research findings can be obtained from the corresponding author upon reasonable request.
Corresponding author: Chuan-Hui Lu, Chief Physician, The Graduate School of Fujian Medical University, No. 1 Xuefu North Road, Shangjie Town, Minhou County, Fuzhou 350122, Fujian Province, China. 46601533@qq.com
Received: January 21, 2026 Revised: February 9, 2026 Accepted: April 14, 2026 Published online: July 15, 2026 Processing time: 166 Days and 9.8 Hours
Abstract
BACKGROUND
Gastric cancer (GC) is a highly aggressive malignant tumor. Radical surgery combined with postoperative adjuvant chemotherapy (AC) is the mainstay treatment for stage III GC. Although current guidelines recommend similar AC strategies for all patients with stage III GC, stage IIIC GC is associated with markedly inferior long-term survival compared to stages IIIA and IIIB. Furthermore, the optimal timing for initiating AC after radical surgery remains uncertain. Therefore, clarifying the aggressive pathological characteristics, identifying key prognostic factors, and evaluating the optimal timing for initiating AC in stage IIIC GC are extremely important for developing individualized postoperative therapeutic strategies.
AIM
To investigate the aggressive pathological characteristics, key prognostic factors and optimal timing for initiating AC in stage IIIC GC.
METHODS
We retrospectively analyzed 122 patients with stage IIIB (n = 60) or IIIC (n = 62) GC who underwent radical surgery followed by AC with S-1 plus oxaliplatin (SOX) or capecitabine plus oxaliplatin regimens. Disease-free survival (DFS) was estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional hazards models to identify prognostic factors.
RESULTS
Age ≥ 60 years, carcinoembryonic antigen (CEA) ≥ 5.0 μg/L, metastatic lymph node ratio (MLR) ≥ 0.5, and the time interval (TI) from surgery to initiation of AC were independent risk factors for recurrence and metastasis after radical surgery of stage IIIC GC. Within stage IIIC cohort, age ≥ 60, CEA ≥ 5.0 μg/L, and MLR ≥ 0.5 predicted shorter DFS. Regarding TI cut offs, 3-year DFS did not differ at < 4 weeks vs ≥ 4 weeks, but was higher at < 6 weeks vs ≥ 6 weeks and < 8 weeks vs ≥ 8 weeks in stage IIIC. In the SOX subgroup, initiating AC within 6 weeks or 8 weeks improved 3-year DFS; however no significant TI effect was observed in the capecitabine plus oxaliplatin subgroup.
CONCLUSION
Age ≥ 60 years, CEA ≥ 5.0 μg/L, MLR ≥ 0.5, and TI are independent risk factors for postoperative recurrence and metastasis in stage IIIC GC. For patients with stage IIIC GC, the optimal time window for initiating postoperative AC is within 6 weeks. Crucially, the SOX regimen exhibits significant time-sensitivity, with an optimal window of within 6 weeks. In contrast, the XELOX regimen did not show this phenomenon.
Core Tip: We identified age ≥ 60 years, carcinoembryonic antigen ≥ 5.0 μg/L, metastatic lymph node ratio ≥ 0.5 and time interval (TI) from surgery to initiation of adjuvant chemotherapy are independent risk factors for postoperative recurrence. Crucially, our findings demonstrate that initiating adjuvant chemotherapy within 6 weeks of surgery significantly improves disease-free survival in stage IIIC patients. Notably, the S-1 plus oxaliplatin regimen exhibits significant time-sensitivity, with an optimal window of within 6 weeks. Whereas the capecitabine plus oxaliplatin regimen does not. These insights provide a rationale for optimizing individualized therapeutic strategies for this high-risk subgroup.
