The efficacy of neoadjuvant chemotherapy is different for type 4 and large type 3 gastric cancer.

BACKGROUND: In the JCOG0501 study, neoadjuvant chemotherapy (NAC) failed to demonstrate survival benefits for type 4 and large type 3 gastric cancer (GC). The prognosis of these patients is still poor. We conducted this study to explore the value of NAC with non-SP regimens for type 4 and large type 3 â€‹GC in the Chinese population. METHODS: We retrospectively collected data from our electronic medical record system. Patients with large type 3 or type 4 â€‹GC who underwent D2 gastrectomy and AC were included. Patients were divided into two groups based on whether they received NAC: the CSC (NAC â€‹+ â€‹surgery â€‹+ â€‹AC) and SC (surgery â€‹+ â€‹AC) groups. The survival and perioperative outcomes for large type 3 or type 4 â€‹GC were analyzed between the CSC and SC groups, separately. RESULTS: Between May 2009 and December 2018, 189 patients were reviewed. Among large type 3 â€‹GC, the 5-year overall survival (OS) rates for patients in the CSC and SC groups were 54.4 â€‹% and 28.0 â€‹%, respectively (P â€‹= â€‹0.0008). Among type 4 â€‹GC, the 5-year OS rates for patients in the CSC and SC groups were 15.8 â€‹% and 24.8 â€‹%, respectively (P â€‹> â€‹0.05). CONCLUSIONS: This study showed NAC can improve the prognosis of large type 3 â€‹GC. However, NAC did not demonstrate significant survival advantages for type 4 â€‹GC.