Optimal Management of Clinical T2N0 Gastric Adenocarcinoma: Surgery or Chemotherapy First?
In brief
Adjuvant chemotherapy cuts death risk 21% versus peri-operative in T2N0 gastric cancer
In a national database of 3,676 patients with clinical T2N0 gastric adenocarcinoma, both peri-operative and adjuvant chemotherapy improved overall survival compared with surgery alone, but adjuvant therapy was linked to a 21% lower mortality than peri-operative regimens. Most patients still received no chemotherapy, highlighting a gap between evidence and practice.
- Journal
- Journal of surgical oncology (Q1)
- Published
- 16 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Elizabeth J Olecki, Rolfy Perez Holguin, Matthew E B Dixon, June S Peng
- PMID
- 42604578
- DOI
- 10.1002/jso.70354
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 23 August 2026): Treatment sequencing study, not pathology classification
- Picked for Surgery (paper of the day, 17 August 2026): Adjuvant chemo improves survival vs peri‑operative in cT2N0 gastric
Abstract
INTRODUCTION: Randomized controlled trials have demonstrated substantial benefit of perioperative chemotherapy (PC) and surgery for locally advanced gastric adenocarcinoma. Patients with clinical T2N0 (cT2N0) gastric adenocarcinoma were included in these trials, but the benefit of PC remains unclear in this intermediate-stage disease due to the small number of patients included. The goal of this study was to determine the role and sequencing of chemotherapy for resected cT2N0 gastric adenocarcinoma. METHODS: The National Cancer Database from 2004 to 2020 was used to identify patients with cT2N0 gastric adenocarcinoma who underwent surgical resection. Patients were stratified by receipt of chemotherapy into three groups: (1) no chemotherapy, (2) perioperative chemotherapy (PC), and (3) adjuvant chemotherapy (AT). The primary outcome was overall survival. RESULTS: Of 3676 patients with cT2N0 gastric adenocarcinoma, 61.3% received no chemotherapy, 19.4% received PC, and 19.2% received AT. Of the 2961 patients who underwent upfront surgical resection, 28.8% (854) were upstaged on final pathology. Multivariable survival analysis revealed that both PC and AT were associated with a decreased mortality compared to no chemotherapy (0.64 and 0.68, respectively, p < 0.001). AT was associated with a 21% decrease in mortality compared to PC (HR 0.79, p = 0.015). CONCLUSION: Patients presenting with cT2N0 gastric adenocarcinoma benefit from chemotherapy in addition to surgery, although a minority of patients received guideline concordant care. Patients who received adjuvant chemotherapy had superior outcomes compared to those who received perioperative chemotherapy. The optimal treatment for cT2N0 gastric cancer should include surgery and chemotherapy, and consideration should be given to a strategy of upfront surgical resection and adjuvant therapy rather than perioperative chemotherapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.