Early conventional initiation of adjuvant chemotherapy in advanced gastric cancer: A propensity-matched outcomes study.

[BACKGROUND] Despite emerging evidence from studies on other malignancies that support early adjuvant chemotherapy (AC) initiation, the feasibility and oncologic benefits of this therapy remain underexplored in patients receiving gastric resection.

[AIM] To evaluate the feasibility, safety, and oncologic outcomes of early postoperative AC in advanced gastric cancer patients.

[METHODS] In this retrospective cohort study, 219 stage II/III gastric adenocarcinoma patients who underwent laparoscopic gastrectomy between 2016 and 2021 were analyzed. Patients were stratified by AC initiation timing: Early (10-13 days, = 21) conventional (4-6 weeks, = 198). Propensity score matching (1:2) was performed, with balance assessed standardized mean differences. Recurrence-free survival, overall survival, and safety were compared between the two groups. Sensitivity analyses were conducted to assess the robustness of the findings.

[RESULTS] After 1:2 matching (21 patients 42 patients), early AC demonstrated comparable 3-year recurrence-free survival (53.7% 61.6%, hazard ratio = 0.89, = 0.562) and overall survival (69.1% 66.3%, = 0.874) rates to conventional timing. Peritoneal recurrence was significantly lower in the early group (4.8% 26.2%, = 0.048), although Cox regression did not confirm a significant difference (hazard ratio = 0.418, = 0.257). Early initiation correlated with a 2.18-fold greater proportion of patients requiring dose reductions (57.1% 26.2%, = 0.026) but similar grade 3/4 toxicity (42.9% 57.1%, = 0.285).

[CONCLUSION] Early AC initiation appears feasible in selected patients but necessitates individualized dose management. Our findings challenge traditional timing paradigms while highlighting the need for molecularly guided treatment sequencing strategies.