| Abstract [eng] |
Introduction. Gastric cancer remains one of the leading causes of cancer-related deaths worldwide, despite advances in diagnosis and treatment. Although surgery remains the primary treatment method, increasing numbers of studies highlight the importance of neoadjuvant chemotherapy in improving survival rates. Aim of the study. To evaluate the validity of neoadjuvant chemotherapy in the treatment of gastric cancer. Objectives of the study. 1.To review the data presented in the scientific literature regarding gastric cancer, treatment options, and the importance of neoadjuvant chemotherapy in the treatment of gastric cancer. 2.To compare treatment outcomes and survival rates in patients with and without neoadjuvant chemotherapy. 3.To evaluate the safety of neoadjuvant chemotherapy. Methods. A retrospective analysis of patients diagnosed with gastric cancer between 2019 and 2022 was performed. A total of 100 patients were included in the final analysis based on inclusion and exclusion criteria. Patients were divided into two groups: group I, which underwent only surgical treatment, and group II, which received neoadjuvant chemotherapy prior to surgery. Demographic characteristics, tumour clinical data, treatment characteristics, postoperative complications, and survival were evaluated. Statistical analysis was performed using Microsoft Office Excel and IBM SPSS Statistics 29 software. Log-rank tests and the Kaplan-Meier method were used for survival analysis. Differences were considered significant when p < 0.05. A literature review was conducted using the PubMed, ScienceDirect, and Elsevier databases. Study results. Patients in group I were statistically significantly older than those in group II (66.78 ± 1.96 vs. 56.52 ± 1.57; p < 0.001), but there were no statistically significant differences between the groups in terms of gender, body mass index, or functional status. Clinical and histological tumour characteristics were similar between groups, with poorly differentiated (G3) tumours predominating. There were no statistically significant differences between the groups in surgical outcomes. A statistically significant difference was found in the lymphovascular invasion (LVI) index; LVI-0 was more frequently observed in patients who received neoadjuvant chemotherapy (group II) (p= 0.008), while higher grades of lymphovascular invasion were detected only in group I. When evaluating the efficacy of neoadjuvant chemotherapy based on tumour regression grade, it was found that complete pathological response (TRG1a) was rare, and more than half of the patients (54 %) had minimal tumour regression (TRG3). The incidence of postoperative complications did not differ significantly between the groups. Survival analysis showed longer three-year overall survival (OS) in patients who received neoadjuvant chemotherapy compared to the group that did not (32.0 vs. 26.7 months). Consistently, longer three-year disease-free survival (DFS) was observed– 30.8 vs. 25.0 months. Statistically significantly longer disease-free survival was observed in stage III patients in group II (28.5 vs. 22.3 months in group I). A similar trend was observed in patients with good functional status (ECOG 0); in group II, disease-free survival was statistically significantly longer than in group I (29.8 vs. 25.7 months). Conclusions. Neoadjuvant chemotherapy is an important part of the treatment of locally advanced gastric cancer. The results of this study demonstrate that its use is justified, as it significantly improves overall survival and disease-free survival compared to surgery alone. Neoadjuvant chemotherapy does not increase the incidence of postoperative complications and is therefore a safe treatment method. The greatest benefit was observed in stage III patients and in patients with good functional status; therefore, the use of neoadjuvant chemotherapy should be individualized, considering the patient’s clinical characteristics and disease features. |
