Neoadjuvant Chemotherapy Followed by Gastrectomy for Cytology-Positive Gastric Cancer without Any Other Non-Curative Factors in a Western Setting: An International Eastern European Cohort Study.

Simple Summary: This multicenter study delved into the outcomes of treating stage IV gastric cancer patients with positive peritoneal cytology but no other non-curative factors using chemotherapy followed by gastrectomy. The findings revealed that preoperative chemotherapy successfully eliminated peritoneal cancer cells in over 50% of patients. The median Overall and Progression-free survival stood at 20 (95% CI: 16–25) and 19 (95% CI: 11–20) months, respectively. Notably, conversion to negative cytology significantly lowered the relative risk of peritoneal progression (RR: 0.11; 95% CI: 0.03–0.47, p = 0.002). This study proposes that preoperative chemotherapy followed by gastrectomy shows promise as a viable treatment for stage IV gastric cancer patients with positive peritoneal cytology and no additional non-curative factors. The conversion of cytology status is associated with enhanced long-term outcomes and diminished risk of peritoneal relapse. The optimal approach for treating cytology-positive (Cy1) gastric cancer (GC) patients without additional non-curative factors remains uncertain. While neoadjuvant chemotherapy followed by gastrectomy shows promise, its suitability for Western patients is not well supported by existing data. To address this knowledge gap, a cohort study was conducted across four major GC treatment centers in Lithuania, Estonia, and Ukraine. Forty-three consecutive Cy1 GC patients who underwent neoadjuvant chemotherapy between 2016 and 2020 were enrolled. The study evaluated overall survival (OS), progression-free survival (PFS), cytology status conversion, and major pathological response rates, along with the factors influencing these outcomes. All patients underwent surgery post-neoadjuvant chemotherapy, with 53.5% experiencing cytological status conversion and 23.3% achieving a major pathological response. The median OS and PFS were 20 (95% CI: 16–25) and 19 (95% CI: 11–20) months, respectively. Conversion to negative cytology significantly reduced the relative risk of peritoneal progression (RR: 0.11; 95% CI: 0.03–0.47, p = 0.002). The study suggests that neoadjuvant chemotherapy followed by gastrectomy holds promise as a treatment option for Cy1 GC without additional non-curative factors, associating cytology status conversion with improved long-term outcomes and reduced peritoneal relapse risk. [ABSTRACT FROM AUTHOR]

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