PERIOPERATIVE CHEMOTHERAPY VERSUS UPFRONT SURGERY WITH ADJUVANT CHEMOTHERAPY IN GASTRIC AND ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA, A RETROSPECTIVE TRIAL

Introduction: gastric cancer represents a common cause of cancer death worldwide. Adenocarcinoma accounts for more than 95% of all gastric malignancies. Are estimated more than 26.000 new cases in United States (US) per year (2021), with 11.000 deaths. In Brazil it represents the 4th most incident cancer in men and the sixth in women, being responsible for more than 15.000 deaths. Objective: this study aimed to compare perioperative chemotherapy versus upfront surgery with adjuvant chemotherapy in gastric and esophagogastric junction adenocarcinoma, in terms of clinical features, survival outcomes and prognostic factors of patients treated in Londrina Cancer Hospital by public health system. Methods: retrospective, single-center study, whose data were collected from electronic medical records by three investigators. Patients aged 18 years or older, treated in the public health system, between January 1 st, 2015 and December 31 st,, 2020, diagnosed with gastric or esophagogastric junction adenocarcinoma Siewert 2 or 3, with cT2-4 or cN + (M0) staging were included. Overal survival (OS) and progression free-survival (PFS) curves were developed according to the Kaplan-Meier method and they were compared using the log-rank test. Results: data from 76 patients (N: 76) were analyzed. In terms of locoregional and distant recurrence, no statistically significant differences were found between the groups, Hazard Ratio (HR) 0.35 [IC 95% 0.09 – 1.34 p: 0.1137] and HR 1.02 [IC 95% 0.36 – 2.88 p: 0.9683], respectively. In the analysis of overall survival, no statistically significant difference was observed, HR 0.71 [IC 95% 0.26 – 1,94 p: 0.5089]. Conclusion: in this study, statistically significant differences were not observed for PFS and OS in the treatment of patients with localized gastric cancer regarding the use of perioperative chemotherapy versus upfront surgery with adjuvant chemotherapy. In the last decade, there has been a drive towards improving perioperative treatment strategies. Future directions with the incorporation of targeted therapy, immunotherapy, and ctDNA analysis will likely consolidate the perioperative treatment strategy as standard.