Comparative Effectiveness of Neoadjuvant and Adjuvant Therapies in Surgically Treated Non-Metastatic Gastric Cancer
Menée à partir de données du registre de l'Hérault en France portant sur 1 268 patients atteints d’un cancer gastrique non métastatique, cette étude analyse la survie en fonction de la stratégie thérapeutique : chirurgie seule, traitement néoadjuvant suivi d’une chirurgie ou chirurgie suivie d’un traitement adjuvant
Objectives: This study evaluates survival differences among patients with non-metastatic gastric cancer based on treatment strategy. It compares three groups: surgery alone, neoadjuvant therapy plus surgery, and surgery followed by adjuvant therapy.
Methods: A retrospective cohort study using data from the Hérault Tumor Registry in France included patients diagnosed with non-metastatic gastric cancer (ICD C16) from 1997 to 2021. Patients who underwent surgery were classified into three treatment groups. Therapies include chemotherapy, radiotherapy, or immunotherapy. Net survival was estimated using the Pohar-Perme method, adjusting for expected general population mortality. Group comparisons used the Log-Rank test, and Cox proportional hazards models provided adjusted hazard ratios. Follow-up ended on December 31, 2023.
Results: Among 1,268 patients, those receiving neoadjuvant therapy plus surgery had significantly lower mortality than surgery alone: adjusted hazard ratios were 0.36 (95% CI: 0.24–0.55) at 1 year, 0.65 (95% CI: 0.51–0.83) at 3 years, and 0.69 (95% CI: 0.55–0.86) at 5 years. At 1-year, net survival was highest for neoadjuvant therapy (90.7%) versus surgery alone (82.3%) and adjuvant therapy (79.8%). By 5 years, surgery alone showed the highest survival (67.5%), exceeding neoadjuvant (52.8%) and adjuvant groups (43.4%). Survival differences were significant (p < 0.0001). No benefit was seen for adjuvant therapy.
Conclusion: Neoadjuvant therapy followed by surgery was associated with a lower adjusted hazard of death in surgically treated patients with non-metastatic gastric cancer. However, substantial baseline differences between treatment groups and the potential for residual confounding should be considered when interpreting these findings. Careful patient selection based on clinical stage, age, and tumor biology remains essential.
European Journal of Surgical Oncology , résumé, 2026