Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Real-world impact of first-line nivolumab plus chemotherapy on conversion surgery and survival outcomes in advanced gastric and esophagogastric junction cancer: a propensity score-matched analysis.
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Sano Akihiko, Nakazawa Nobuhiro, Kuriyama Kengo, Okada Takuhisa, Shiraishi Takuya, Kumakura Yuji, Kimura Akiharu, Sakai Makoto, Shirabe Ken, Saeki Hiroshi
Аннотация
BACKGROUND: Conversion surgery, namely curative-intent resection for patients with initially unresectable stage IV gastric or esophagogastric junction cancer whose tumors become resectable after systemic therapy, has become an important treatment strategy. However, the selection criteria for conversion surgery in the era of first-line nivolumab remain unclear.
METHODS: This single-institutional retrospective study included 140 patients who received systemic chemotherapy for advanced gastric or esophagogastric junction cancer. Data were compared between treatments with and without first-line nivolumab, and 1:2 propensity score matching was performed to adjust for baseline tumor burden and metastatic status. Predictors of conversion surgery were evaluated using logistic regression, and survival outcomes were analyzed using Kaplan-Meier and Cox regression models.
RESULTS: Conversion surgery was performed in 22 (15.7%) patients. The conversion surgery rate was significantly higher in patients receiving first-line nivolumab than in those receiving chemotherapy alone, both before and after propensity score matching (41.7% vs 8.3%; P =.001). In a multivariate analysis, the use of nivolumab as a first-line treatment was an independent predictor of conversion surgery both before and after matching. Minimally invasive surgery was performed in 12 (54.5%) patients, 9 of whom had received nivolumab. In the multivariate analysis of the propensity score-matched population, first-line nivolumab and male sex were favorable prognostic factors for advanced gastric cancer.
CONCLUSION: First-line nivolumab-based chemotherapy may increase the likelihood of conversion surgery in patients with advanced gastric or esophagogastric junction cancer. Although conversion surgery was associated with improved progression-free survival, its impact on overall survival remains uncertain.
METHODS: This single-institutional retrospective study included 140 patients who received systemic chemotherapy for advanced gastric or esophagogastric junction cancer. Data were compared between treatments with and without first-line nivolumab, and 1:2 propensity score matching was performed to adjust for baseline tumor burden and metastatic status. Predictors of conversion surgery were evaluated using logistic regression, and survival outcomes were analyzed using Kaplan-Meier and Cox regression models.
RESULTS: Conversion surgery was performed in 22 (15.7%) patients. The conversion surgery rate was significantly higher in patients receiving first-line nivolumab than in those receiving chemotherapy alone, both before and after propensity score matching (41.7% vs 8.3%; P =.001). In a multivariate analysis, the use of nivolumab as a first-line treatment was an independent predictor of conversion surgery both before and after matching. Minimally invasive surgery was performed in 12 (54.5%) patients, 9 of whom had received nivolumab. In the multivariate analysis of the propensity score-matched population, first-line nivolumab and male sex were favorable prognostic factors for advanced gastric cancer.
CONCLUSION: First-line nivolumab-based chemotherapy may increase the likelihood of conversion surgery in patients with advanced gastric or esophagogastric junction cancer. Although conversion surgery was associated with improved progression-free survival, its impact on overall survival remains uncertain.