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Background: The aim of this study was to evaluate the effect of neoadjuvant therapies (NAT) on patients with locally advanced gastric cancer (LAGC). Methods: This study retrospectively analyzed LAGC patients treated at the China National Cancer Center between October 2006 and December 2018. All patients included were divided into two groups, NAT followed by surgery (NAT-Surgery) and adjuvant chemotherapy following surgery (Surgery-ACT). Subgroup analysis compared between patients underwent either neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiation (nCRT) was conducted. Propensity score matching (PSM) was implemented to reduce selection bias. Results: In total, 2779 patients were included in this study (494 of NAT-Surgery group and 2285 of Surgery-ACT group). After PSM, the patients in NAT-Surgery group had a significantly longer overall survival (OS) than patients in Surgery-ACT group (P

Background: Neoadjuvant chemotherapy (NAC) has been shown to improve the prognosis for patients with locally advanced gastric cancer (LAGC). Neutropenia, a predominant chemotherapy-related adverse event, affects the therapeutic course for NAC. Methods: Data for 233 patients with LAGC treated with NAC and curative gastrectomy at our center were retrospectively analysed in terms of the relationship between neutropenia and clinicopathological features or outcomes. Results: NAC-induced neutropenia, NAC-induced severe (grade 3/4) neutropenia (NISN), and a favorable histopathological response (HPR) were observed in 102 (43.8%), 35 (15.0%), and 103 (44.2%) patients, respectively. Together with tumor differentiation, clinical response, and lymphovascular invasion (LVI), and NISN independently predicted a favorable HPR [odds ratio (OR) =4.158, 95% confidence interval (CI): 1.762–9.812, P=0.001). Among patients treated with postoperative chemotherapy, NISN independently predicted poor compliance with postoperative chemotherapy (OR 0.364, 95% CI: 0.148–0.894, P=0.028) and thus poor overall survival (OS) and disease-free survival (DFS). Among patients treated with preoperative chemotherapy alone, NISN was associated with a tendency towards a better DFS (P=0.116) and independently predicted superior OS (hazard ratio =0.253, 95% CI: 0.077–0.830, P=0.023). Conclusions: In conclusion, our study revealed a link between NISN, HPR, treatment compliance, and survival. NISN is useful for guiding treatment strategies and predicting prognosis for LAGC patients.

Background Adenocarcinoma in Esophagogastric Junction (AEG) is a severe gastrointestinal malignancy with a unique clinicopathological feature. Hence, we aimed to develop a competing risk nomogram for predicting survival for AEG patients and compared it with new 8th traditional tumor-node-metastasis (TNM) staging system. Methods Based on data from the Surveillance, Epidemiology, and End Results (SEER) database of AEG patients between 2004 and 2010, we used univariate and multivariate analysis to filter clinical factors and then built a competing risk nomogram to predict AEG cause-specific survival. We then measured the clinical accuracy by comparing them to the 8th TNM stage with a Receiver Operating Characteristic (ROC) curve, Brier score, and Decision Curve Analysis (DCA). External validation was performed in 273 patients from China National Cancer Center. Results A total of 1755 patients were included in this study. The nomogram was based on five variables: Number of examined lymph nodes, grade, invasion, metastatic LNs, and age. The results of the nomogram was greater than traditional TNM staging with ROC curve (1-year AUC: 0.747 vs. 0.641, 3-year AUC: 0.761 vs. 0.679, 5-year AUC: 0.759 vs. 0.682, 7-year AUC: 0.749 vs. 0.673, P P = 0.012; 5-year: 0.198 vs. 0.216, P = 0.008; 7-year: 0.199 vs. 0.215, P = 0.014) and DCA. In external validation, the nomogram also showed better diagnostic value than traditional TNM staging and great prediction accuracy. Conclusion We developed and validated a novel nomogram and risk stratification system integrating clinicopathological characteristics for AEG patients. The model showed superior prediction ability for AEG patients than traditional TNM classification.

Background: Adenocarcinoma in Esophagogastric Junction (AEG) is a severe gastrointestinal malignancy with a unique clinicopathological feature. To develop a competing risk nomogram for AEG patients and compared it with new 8th traditional tumor-node-metastasis (TNM) staging system.Methods: Based on AEG patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2010, we used the univariate and multivariate analysis to filter clinical factors and then built the competing risk nomogram to predicting the AEG cause-specific survival. We measured the clinical accuracy by comparing to the 8th TNM stage with receiver operating characteristic (ROC) curve, Brier score, and decision curve analysis (DCA).Results: Total of 1755 patients were included into this study. This nomogram was based on five variables: Number of examined lymph nodes, grade, invasion, metastatic LNs and age. The nomogram model was greater than traditional TNM staging with ROC curve (1-year AUC:0.747 vs. 0.641, 3-year AUC: 0.761 vs. 0.679, 5-year AUC: 0.759 vs. 0.682, 7-year AUC: 0.749 vs. 0.673, P

Background: Lifestyle factors such as body mass index (BMI), alcohol drinking, and cigarette smoking, are likely to profoundly impact the prognosis of gastric cancer, but evidence has been inconsistent. Methods: Patients with gastric cancer were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) 1998-2018. Survival analysis performed via Kaplan-Meier estimates and Cox proportional hazards models. Results: In this study, we reviewed 18 441 cases of gastric cancer patients. Individuals who were overweight or obese was associated with positive smoking and drinking history (P=0.002 and P10% groups), but not BMI values at diagnosis, was related to survival results. For other factors, smoking history of more than 30 years conferred a worse prognosis for only gastrectomy patients. Extensive efforts are needed to elucidate mechanisms targeting the complex effects of lifestyles factors.

Background Primary tumor resection (PTR) and lymph node dissection (LND) may be performed occasionally in patients with de novo metastatic pancreatic ductal adenocarcinoma (mPDAC). However, the role of PTR and LND in such cases remains unclear. Thus, we aimed to test the effect of PTR and LND on overall survival (OS) and cancer-specific survival (CSS) in mPDAC patients. Methods Patients with de novo mPDAC were identified from the Surveillance Epidemiology and End Results (SEER) database (2010–2015). The inverse probability of treatment weighting (IPTW) method was used to minimize the selection bias. IPTW-adjusted Kaplan-Meier curves and Cox proportional hazards models were used to compare OS and CSS in different treatment groups. Results A total of 10,036 patients met the inclusion criteria. Of these patients, 275 (2.7%) underwent PTR, while 217 (2.2%) also underwent LND with a median of 16 nodes removed. In the IPTW-adjusted Kaplan-Meier analysis, the median OS was 13 versus 6 months (P

Background: Gastrectomy is usually recommended within 5 to 6 weeks after the completion of neoadjuvant chemotherapy (NCT). However, the optimal timing of surgery is not clearly defined. Methods: This study retrospectively reviewed the clinical records of 229 patients with locally advanced gastric cancer (GC) who underwent curative gastrectomy after NCT between 2006 and 2016. The effect of the time to surgery (TTS), defined as ≤4, 5–6, and >6 weeks, on patient outcomes was examined. Descriptive statistics and Cox proportional hazards models were used. Results: Seventy of 229 patients (30.6%) had surgery within 4 weeks after their last dose of NCT, 103 (45.0%) within 5–6 weeks, and 56 (24.5%) after 6 weeks. The median age was 56.0 [interquartile range (IQR), 47.0–63.0] years, and the median TTS was 34.0 (IQR, 26.0–42.0) days. The three groups did not significantly differ regarding most surgical and histopathological characteristics except for the NCT regimen (P=0.010), number of cycles of NCT (P=0.017) and pathological stage (P=0.015). The NCT regimen was the only independent factor associated with TTS >6 weeks (P=0.015). The 3-year progression-free survival (PFS) estimates were 41.9%, 42.8% and 61.7% in patients who underwent surgery in ≤4, 5–6, and >6 weeks after NCT, respectively (P=0.044). The 3-year overall survival (OS) estimates were 57.7%, 58.0% and 68.2% in the three groups, respectively (P=0.202). According to multivariable analysis, compared with the interval of ≤4 weeks, patients who underwent surgery at 5–6 or >6 weeks had equivalent PFS and OS. Conclusions: The NCT-surgery interval time has no impact on patient outcomes.

Background/Aims: Evidence regarding gastric cancer (GC) patients