AccScience Publishing / JBM / Online First / DOI: 10.14440/jbm.2025.0135
Submit to JBM
Cite this article
4
Download
82
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW

Survival outcomes in patients with stages I–III gastric adenocarcinoma treated with surgery alone versus surgery plus adjuvant chemotherapy: A systematic review

Naveena Kaur Rikhraj1,2,3*
Show Less
1 Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire PR2 9HT, United Kingdom
2 Department of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester M13 9PL, United Kingdom
3 Department of Medicine, School of Medicine, University of St Andrews, Fife, Scotland KY16 9TF, United Kingdom
JBM, e99010060 https://doi.org/10.14440/jbm.2025.0135
Submitted: 3 December 2024 | Revised: 27 February 2025 | Accepted: 28 March 2025 | Published: 18 April 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

Background: Gastric adenocarcinoma, the malignant proliferation of glandular cells in stomach epithelium, is a type of gastric cancer with a statistical disease burden of the fifth most common cancer globally and the 17th most common malignancy in the United Kingdom. Prognosis varies with stage (I–IV), with stages I–III showing promising 5-year survival rates up to 71.8%, warranting timely diagnosis and treatment. Surgery is the gold-standard treatment; however, due to complex tumor pathophysiology, there is growing interest in the use of multimodal therapies. Specifically, the combination of surgery and adjuvant chemotherapy has become a key focus of the treatment for stages I–III gastric adenocarcinoma. Objective: The study reviewed patients with stages I–III (non-advanced) gastric adenocarcinoma to assess whether adjuvant chemotherapy combined with surgery provides better disease-free/disease-specific/cause-specific survival, overall survival, and reduced recurrence rates/improved recurrence-free survival, compared to surgery alone. Analyzed were 17 English-language, full-text, levels I–III peer-reviewed studies from MEDLINE and Embase from the past 10 years were analyzed. No age/sex/ethnicity/country restrictions were applied, and the dimension of interest was limited to stages I–III gastric adenocarcinoma patients who underwent tumor resection through surgery and received chemotherapy as the only adjuvant therapy. Seven (41.2%) studies have more than one statistically significant outcome measure supporting the benefit of adjuvant chemotherapy in combination with surgery over surgery alone. Ten (58.8%) studies showed no statistically significant benefit of adjuvant chemotherapy. Conclusion: The findings contrasted with previous large-scale meta-analyses, which were limited by sample size and biases in individual studies reviewed. Continued research, incorporating advances in surgical techniques and new chemotherapeutic combinations, is necessary to ascertain best-tailored treatments for gastric adenocarcinoma.

Keywords
Gastric adenocarcinoma
Adjuvant chemotherapy
Gastrectomy
Disease-free survival
Overall survival
Recurrence-free survival
Funding
None.
Conflict of interest
The author declares no conflicts of interest.
References
  1. GLOBOCAN. Stomach. 2020. Available from: https://gco. iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf [Last accessed on 2023 Jan 28].

 

  1. Ralston SH, Penman DI, Strachan JWM, Hobson R. Davidson’s Principles and Practice of Medicine. 23rd ed. London: Elsevier; 2018.

 

  1. Cancer Research UK. Stomach Cancer Statistics. 2022. Available from: https://www.cancerresearchuk.org/ health-professional/cancer-statistics/statistics-by-cancer-type/stomach-cancer#:~:text=stomach%20cancer%20 risk&text=1%20in%2076%20uk%20males,in%20the%20 uk%20are%20preventable [Last accessed on 2023 Jan 31].

 

  1. Kim JS, Choi WC. Common locations of gastric cancer: Review of research from the endoscopic submucosal dissection era. J Korean Med Sci. 2019;34(35):e231. doi: 10.3346/jkms.2019.34.e231

 

  1. Kang DH, Choi CW, Kim HW, et al. Location characteristics of early gastric cancer treated with endoscopic submucosal dissection. Surg Endosc. 2017;31(11):4673-4679. doi: 10.1007/s00464-017-5534-9

 

  1. Young JJ, Pahwa A, Patel M, et al. Ligaments and lymphatic pathways in gastric adenocarcinoma. Radiographics. 2019;39(3):668-689. doi: 10.1148/rg.2019180113

 

  1. Innes JA, Dover RA, Fairhurst K. Macleod’s Clinical Examination. 14th ed. Amsterdam: Elsevier; 2018.

 

  1. Chiu YWP, Sano Y, Uedo N, Singh R, editors. Endoscopy in Early Gastrointestinal Cancers. Vol. 1. Berlin, Germany: Springer; 2021.

 

  1. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101-112. doi: 10.1007/s10120-011-0041-5

 

  1. Lauren P. The two histological main types of gastric carcinoma: Diffuse and so-called intestinal-type carcinoma. An attempt at histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31-49. doi: 10.1111/apm.1965.64.1.31

 

  1. Strayer SD, Rubin E. Rubin’s Pathology Clinicopathological Foundations of Medicine. 7th ed. Philedelphia, PA: Lippincott Williams and Wilkins; 2015.

 

  1. Goljan FE. Rapid Review Pathology. 2nd ed. India: Elsevier; 2019.

 

  1. Sato Y, Okamoto K, Kawano Y, et al. Novel biomarkers of gastric cancer: Current research and future perspectives. J Clin Med. 2023;12:4646. doi: 10.3390/jcm12144646

 

  1. Hopkins S, Yang YG. FDG PET imaging in the staging and management of gastric cancer. J Gastrointest Oncol. 2011;2: 39-44. doi: 10.3978/j.issn.2078-6891.2010.004

 

  1. AJCC. Stomach Cancer Stages. 2018 Available from: https:// www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/staging.html [Last accessed on2023 Feb 15].

 

  1. SEER. Cancer Stat Facts: Stomach Cancer. 2018. Available from: https://seer.cancer.gov/statfacts/html/stomach.html [Last accessed on 2023 Feb 15].

 

  1. Bhat S, Pai GK, Pandit A. SRB’s Surgical Operations Text and Atlas. India: J. P. Medical; 2014.

 

  1. Marelli D, Piccioni AS, Carbone L, et al. Posterior and para-aortic (D2plus) lymphadenectomy after neoadjuvant/ conversion therapy for locally advanced/oligometastatic gastric cancer. Cancers (Basel). 2024;16(7):1376. doi: 10.3390/cancers16071376

 

  1. He L, Zhao Y. Is Roux-en-Y or Billroth-II reconstruction the preferred choice for gastric cancer patients undergoing distal gastrectomy when Billroth I reconstruction is not applicable? A meta-analysis. Medicine (Baltimore). 2019;98(48):e17093. doi: 10.1097/MD.0000000000017093

 

  1. Wang S, Xu L, Wang Q, et al. Postoperative complications and prognosis after radical gastrectomy for gastric cancer: A systematic review and meta-analysis of observational studies. World J Surg Oncol. 2019;17(1):52. doi: 10.1186/s12957-019-1593-9

 

  1. Xiang YY, Deng CC, Liu YH, Kuo ZC, Zhang CH, He YL. The prognostic effect of multidisciplinary team intervention in patients with advanced gastric cancer. Curr Oncol. 2022;29(2):1201-1212. doi: 10.3390/curroncol29020102

 

  1. Aoyama T, Yoshikawa T, Fujikawa H, et al. Exploratory analysis to find unfavourable subset of stage II gastric cancer for which surgery alone is the standard treatment; Another target for adjuvant chemotherapy. Int Surg. 2014;99(6):835-841. doi: 10.9738/INTSURG-D-13-00176.1

 

  1. Cho HJ, Lim YJ, Cho YJ. Comparison of capecitabine and oxaliplatin with S-1 as adjuvant chemotherapy in stage III gastric cancer after D2 gastrectomy. PLoS One. 2017;12(10):e0186362. doi: 10.1371/journal.0186362

 

  1. Wada T, Kunisaki C, Hasegawa S, et al. Factors predictive of recurrence after surgery for gastric cancer followed by adjuvant S-1 chemotherapy. Anticancer Res. 2013;33:1747-1751.

 

  1. Diaz-Nieto R, Orti-Rodriguez R, Winslet M. Post-surgical chemotherapy versus surgery alone for resectable gastric cancer. Cochrane Database Syst Rev. 2013l;2(9):CD008415. doi: 10.1002/14651858.CD008415.pub2

 

  1. Peters JDM. Postsurgical chemotherapy vs. surgery alone for resectable gastric cancer. Am J Nurs. 2014;114(7):24. doi: 10.1097/01.NAJ.0000451679.81694.61

 

  1. Mari E, Floriani I, Tinazzi A, Barni S, Labianca R, Torri V. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: A meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente. Ann Oncol. 2000;11(7):837-843. doi: 10.1023/a:1008377101672

 

  1. GASTRIC Group. Benefit of adjuvant chemotherapy for resectable gastric cancer: A meta-analysis. JAMA. 2010;303(17):1729-1737. doi: 10.1001/jama.2010.534

 

  1. Lee KG, Lee HJ, Oh SY, et al. Is there any role of adjuvant chemotherapy for T3N0M0 or T1N2M0 gastric cancer patients in stage II in the 7th TNM but stage I in the 6th TNM system? Ann Surg Oncol. 2016;23:1234-1243. doi: 10.1245/s10434-015-4980-7

 

  1. Noh HS, Park RS, Yang KH, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2024;15(12):1389-1396. doi: 10.1016/S1470-2045(14)70473-5

 

  1. Moon HJ, Fujiwara Y, Hirao M, et al. Randomized controlled trial of adjuvant chemotherapy with fluoropyrimidines versus surgery-alone for gastric cancer. Anticancer Res. 2017;37(6):3061-3067. doi: 10.21873/anticanres.11661

 

  1. Chen L, Zhang C, Yao Z, et al. Adjuvant chemotherapy is an additional option for locally advanced gastric cancer after radical gastrectomy with D2 lymphadenectomy: A retrospective control study. BMC Cancer. 2021;21(1):974. doi: 10.1186/s12885-021-08717-4

 

  1. Serrano M, Araujo MJ, Pacheco C, et al. Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer. Ecancermedicalscience. 2022;16:1387. doi: 10.3332/ecancer.2022.1387

 

  1. Lee MC, Yoo WM, Son GY, et al. Long-term efficacy of S-1 monotherapy or capecitabine plus oxaliplatin as adjuvant chemotherapy for patients with stage II or III gastric cancer after curative gastrectomy: A propensity score-matched multicenter cohort study. J Gastric Cancer. 2020;20(2):152-164. doi: 10.5230/jgc.2020.20.e13

 

  1. Oba K, Paoletti X, Alberts S, et al. Disease-free survival as a surrogate for overall survival in adjuvant trials of gastric cancer: A meta-analysis. J Natl Cancer Inst. 2013;105(21):1600-1607. doi: 10.1093/jnci/djt270

 

  1. Huang NZ, Desiderio J, Chen YQ, et al. Indications for adjuvant chemotherapy in patients with AJCC stage IIa T3N0M0 and T1N2M0 gastric cancer-an east and west multicenter study. BMC Gastroenterol. 2019;19(1):205. doi: 10.1186/s12876-019-1096-8

 

  1. Bajetta E, Floriani I, Bartolomeo DM, et al. Randomized trial on adjuvant treatment with FOLFIRI followed by docetaxel and cisplatin versus 5-fluorouracil and folinic acid for radically resected gastric cancer. Ann Oncol. 2014;25(7):1373-1378. doi: 10.1093/annonc/mdu146

 

  1. Kanda M, Murotani K, Kobayashi D, et al. Postoperative adjuvant chemotherapy with S-1 alters recurrence patterns and prognostic factors among patients with stage II/III gastric cancer: A propensity score matching analysis. Surgery. 2015;158(6):1573-1580. doi: 10.1016/j.surg.2015.05.017

 

  1. Jin P, Ji X, Ma S, et al. Adjuvant chemotherapy indications for stage I gastric cancer patients with negative lymph node. Clin Res Hepatol Gastroenterol. 2021;45(6):101634. doi: 10.1016/j.clinre.2021.11634

 

  1. Kang M, Youn GH, An YJ, et al. Adjuvant chemotherapy vs. surgery alone for pT3N0M0 gastric cancer. Ann Surg Oncol. 2021;28:1437-1444. doi: 10.1245/s10434-020-09063-8

 

  1. Mei Y, Feng X, Feng T, et al. Adjuvant chemotherapy in pT2N0M0 gastric cancer: Findings from a retrospective study. Front Pharmcol. 2022;13:845261. doi: 10.3389/fphar.2022.845261

 

  1. Kano Y, Ohashi M, Hiki N, et al. Favourable long-term outcomes of one-year adjuvant S-1 monotherapy for pathological stage II or III gastric cancer treated at a high-volume center. Gastric Cancer. 2018;21:1024-1030. doi: 10.1007/s10120-018-0827-9

 

  1. Takahashi R, Ohashi M, Kano Y, et al. Timing and site-specific trends of recurrence in patients with pathological stage II or III gastric cancer after curative gastrectomy followed by adjuvant S-1 monotherapy. Gastric Cancer. 2019;22:1256-1262. doi: 10.1007/s10120-019-00953-9
Next article in this issue
Share
Back to top
Journal of Biological Methods, Electronic ISSN: 2326-9901 Print ISSN: TBA, Published by POL Scientific
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept