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Timing of Adjuvant Chemotherapy and Impact on Survival for Resected Gastric Cancer

Erin K. Greenleaf MD, Afif N. Kulaylat MD, Christopher S. Hollenbeak PhD, Khaldoun Almhanna MD, MPH, Joyce Wong MD
Gastrointestinal Oncology
Volume 23, Issue 13 / December , 2016



Because postoperative convalescence often prolongs the interval between surgery and chemotherapy in patients undergoing treatment for advanced gastric cancer, this study assesses the survival impact of timing of adjuvant chemotherapy (AC) in patients undergoing curative resection for gastric cancer.


The 2003–2012 ACS NCDB was analyzed for patients treated with gastrectomy for stages 1–3 gastric cancer. Treatment groups were stratified by time to initiation of AC: initiation of chemotherapy within 8 weeks postoperatively, between 8 and 12 weeks postoperatively, after 12 weeks postoperatively, and no chemotherapy. Univariate and multivariate analyses were performed.


Of 7942 patients undergoing gastrectomy, 29 % received AC. Of those who received AC, 58 % initiated AC within 8 weeks, 28 % initiated AC between 8 and 12 weeks, and 14 % received AC after 12 weeks. Among patients who received AC, median survival was not significantly different between time cohorts, even when stratified by pathologic stage. Median survival was longer for chemotherapy cohorts when compared with the no chemotherapy cohort, specifically in patients with pathologic stages 2 and 3 disease. In multivariable analysis, patients who received AC had a 27–29 % lower hazard of death (p < .0001), with administration of AC at any time, compared with patients who did not receive AC, but had no difference in hazard when comparing delayed AC to earlier administration of AC.


Time to initiation of AC does not impact survival. With improved survival over patients who did not receive AC, even delayed initiation of chemotherapy should be offered, when appropriate.

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