title: Timing of chemotherapy and survival in patients with resectable gastric adenocarcinoma.
abstract: OBJECTIVE
  To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups.
  
  
  METHODS
  Patients with surgically resected gastric adenocarcinoma from 1988 to 2006 were identified from the Los Angeles County Cancer Surveillance Program. To evaluate the population most likely to receive and/or benefit from adjunct chemotherapy, inclusion criteria consisted of Stage II or III gastric cancer patients > 18 years of age who underwent curative-intent surgical resection. Patients were categorized into three groups according to the receipt of chemotherapy: (1) no chemotherapy; (2) preoperative chemotherapy; or (3) postoperative chemotherapy. Clinical and pathologic characteristics were compared across the different treatment arms.
  
  
  RESULTS
  Of 1518 patients with surgically resected gastric cancer, 327 (21.5%) received perioperative chemotherapy. The majority of these 327 patients were male (68%) with a mean age of 61.5 years; and they were significantly younger than non-chemotherapy patients (mean age, 70.7; P < 0.001). Most patients had tumors frequently located in the distal stomach (34.5%). Preoperative chemotherapy was administered to 11.3% of patients (n = 37) and postoperative therapy to 88.7% of patients (n = 290). An overall survival benefit according to timing of chemotherapy was not observed on univariate or multivariate analysis. Similar results were observed with stage-specific survival analyses (5-year overall survival: Stage II, 25% vs 30%, respectively; Stage III, 14% vs 11%, respectively). Therefore, our results do not identify a survival advantage for specific timing of chemotherapy in locally advanced gastric cancer.
  
  
  CONCLUSIONS
  This study supports the implementation of a randomized trial comparing the timing of perioperative therapy in patients with locally advanced gastric cancer.
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Arrington
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nelson
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Supriya S
authors.initials: SS
authors.lastname: Patel
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Carrie
authors.initials: C
authors.lastname: Luu
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ko
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.affiliation: Amanda K Arrington, Michelle Ko, Joseph Kim, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
keywords: Adjunct therapy; Chemotherapy; Gastric cancer; Postoperative therapy; Preoperative therapy; Timing