From the Guidelines
There is a significant association between progression-free survival and overall survival in resectable gastric cancer, as evidenced by the improvement in both outcomes with perioperative chemotherapy. The study by 1 demonstrated that perioperative chemotherapy with the ECF regimen significantly improved progression-free and overall survival in patients with operable gastric and lower esophageal adenocarcinomas. Key findings from this study include:
- A greater proportion of pathologic T1 and T2 tumors in the perioperative chemotherapy group (51.7%) compared to the surgery group (36.8%)
- Five-year survival rates of 36% among those who received perioperative chemotherapy and 23% in the surgery group
- Perioperative chemotherapy with the ECF regimen significantly improved progression-free and overall survival in patients with operable gastric and lower esophageal adenocarcinomas. This association is biologically plausible because preventing or delaying disease recurrence allows patients to maintain better functional status, receive subsequent lines of therapy if needed, and avoid complications of progressive disease. Understanding this relationship is clinically important as it helps oncologists evaluate treatment efficacy earlier than waiting for OS data and guides decision-making regarding adjuvant therapy options for individual patients.
From the Research
Association Between Progression Free Survival and Overall Survival
- The study 2 found that perioperative chemotherapy improved progression-free survival and overall survival in patients with resectable gastric cancer.
- Another study 3 reported that perioperative chemotherapy resulted in an improvement in overall survival and progression-free survival in patients with localized gastric cancer.
- A review of current and future strategies for improving outcomes in resectable gastric cancer 4 discussed the importance of optimizing chemotherapy regimens and investigating combinations of chemotherapy and biologic agents to improve progression-free survival and overall survival.
- A Cochrane review 5 found that chemotherapy improved overall survival in advanced gastric cancer, but the association between progression-free survival and overall survival was not explicitly stated.
Chemotherapy Regimens and Survival
- The study 2 used chemotherapy regimens such as ECF, EOX, or FLOT, and found that patients receiving perioperative chemotherapy per protocol had a more marked absolute improvement in 5-year overall survival.
- The Cochrane review 5 compared different chemotherapy regimens, including irinotecan, docetaxel, oxaliplatin, and S-1, and found that some regimens improved overall survival, but the association between progression-free survival and overall survival was not explicitly stated.
- An older study 6 used the ECF regimen as neoadjuvant chemotherapy in gastro-oesophageal cancer and found encouraging symptomatic and objective responses, but no instances of complete pathological response.
Limitations and Future Directions
- The studies 2, 3, 4, 5, 6 had varying sample sizes, chemotherapy regimens, and outcomes, making it difficult to draw firm conclusions about the association between progression-free survival and overall survival in resectable gastric cancer.
- Further research is needed to optimize chemotherapy regimens and investigate combinations of chemotherapy and biologic agents to improve progression-free survival and overall survival in resectable gastric cancer.