Neoadjuvant Chemotherapy plus Surgery versus Direct Surgery in Senile Patients with Gastric Cancer: Single-Center Retrospective Cohort Study

Background Despite the lack of decisive research advocating neoadjuvant chemotherapy there is a broad consensus that it is beneficial for gastric cancer in terms of survival. However, there is no comparative research on whether it is similarly helpful in senile patients with the age above 75 years old. Here we compared the survival rate between neoadjuvant plus surgery with Direct Surgery. Methods We analyzed 79 patients with locally advanced gastric cancer who were preoperatively suspicious of serosa positive or beyond (cT4a or cT4b); or extensive lymph node involvement (cN3). Postoperative complications and overall survival rate were compared between the patients who underwent neoadjuvant chemotherapy (NAC) plus surgery and the patients who had direct surgery. Results A total of 15 (19%) patients underwent neoadjuvant chemotherapy and 64 (81%) patients had direct surgery. The median follow-up time was 34 months (range of 24-60 months). While the median survival time was not reached in the direct surgery group, the median survival time for the NAC plus Surgery Group was 37 months. Two years of overall survival (OS) for the patients in the NAC plus Surgery group and direct surgery group were 53.3% and 70.3% respectively. There was no statistical difference between the two groups (p>0.05) in overall postoperative complication and length of postoperative stay. Conclusions Reduced does of neoadjuvant chemotherapy was feasible in senile patients. There was no difference in survival rate between the patients who had neoadjuvant plus surgery compared to those who had direct surgery. While this result contradicts the previous assumption that neoadjuvant chemotherapy is beneficial for late-stage gastric cancer patients, a well-controlled prospective study is mandatory for a better understanding of whether neoadjuvant chemotherapy is beneficial to senile patients too. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The overall costs of this research will be funded by grants from the National Natural Science Foundation of China No. 81871904 (ZG Zhu), and No.82103396(ZJ Yu). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Ruijin Hospital approved this study and waived the individual informed consent due to the retrospective analysis. The study was carried out in conformity with the Declaration of Helsinki (as revised in 2013) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.