Triplet versus doublet neoadjuvant chemotherapy regimens for locally advanced gastric cancer: a propensity score matching analysis

Yonghe Chen; Jiasheng He; Dan Liu; Jian Xiao; Xijie Chen; Haijie Tang; Dandong Luo; Chenyu Shang; Lei Lian; Junsheng Peng

doi:10.1186/s12885-021-09093-9

Triplet versus doublet neoadjuvant chemotherapy regimens for locally advanced gastric cancer: a propensity score matching analysis

BMC Cancer. 2021 Dec 13;21(1):1328. doi: 10.1186/s12885-021-09093-9.

Authors

Yonghe Chen^#^{1

2}, Jiasheng He^#^{1

2}, Dan Liu^#³, Jian Xiao⁴, Xijie Chen^{1

2}, Haijie Tang^{2

4}, Dandong Luo^{1

2}, Chenyu Shang³, Lei Lian^{5

6}, Junsheng Peng^{7

8}

Affiliations

¹ Department of Gastric Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, China.
² Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China.
³ Department of Laboratory Science, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510105, China.
⁴ Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
⁵ Department of Gastric Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, China. lianlei2@mail.sysu.edu.cn.
⁶ Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China. lianlei2@mail.sysu.edu.cn.
⁷ Department of Gastric Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, China. pengjsh@mail.sysu.edu.cn.
⁸ Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, 510655, China. pengjsh@mail.sysu.edu.cn.

^# Contributed equally.

Abstract

Background: To investigate the differences between doublet and triplet neoadjuvant chemotherapy (NAC) regimens in efficacy and safety profile.

Methods: A total of 227 locally advanced gastric cancer (LAGC) patients who received NAC and sequential radical gastrectomy were reviewed. After propensity score matching (PSM), 140 patients with similar baseline characteristics were selected. Among them, 70 received doublet NAC regimens consisted of platinum and fluorouracil; the other 70 received triplet NAC regimens consisted of docetaxel, platinum, and fluorouracil.

Results: The efficacy of doublet and triplet regimens was comparable after propensity score matching in terms of tumor regression (pathological complete response, Doublet 11.4% vs. Triplet 15.7%, p = 0.642), achieving of R0 resection (Doublet 88.6% vs. Triplet 88.6%, p = 1), 1-year disease-free survival (DFS) (Doublet 77.1% vs. Triplet 68.6%, p = 0.178), 3-years overall survival (OS) (Doublet 54.3% vs. Triplet 60.9%, p = 0.941). Post-surgery complications were more common in the triplet cohort (Doublet 5.7% vs. Triplet 27.1%, p = 0.001), especially abdominal infection (Doublet 0% vs. Triplet 11.1%, p = 0.001).

Conclusions: A more intense preoperative triplet NAC regimen does not bring extra downstage effect and survival benefit compared to a doublet regimen. It may even result in a higher risk of post-surgery complications.

Keywords: Gastric cancer; Neoadjuvant chemotherapy; Propensity score matching; Survival.

MeSH terms

Antineoplastic Agents* / administration & dosage
Antineoplastic Agents* / adverse effects
Antineoplastic Agents* / therapeutic use
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy*
Postoperative Complications / epidemiology
Propensity Score
Stomach Neoplasms* / epidemiology
Stomach Neoplasms* / mortality
Stomach Neoplasms* / pathology
Stomach Neoplasms* / therapy

Substances

Antineoplastic Agents