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Abstract
Introduction. Gastric cancer (GC) remains one of the most aggressive malignancies worldwide. Delays in treatment initiation following morphological diagnosis of some oncological diseases may adversely impact survival prognosis.
Aim. To evaluate the influence of the time from diagnosis to surgery (TDTS) on tumor-specific survival (TSS) in radically resected GC patients (2010–2023), and to assess real-world GC treatment outcomes of perioperative chemotherapy combined with surgery.
Materials and Methods. We analyzed anonymized data from all GC cases treated between 2010 and 2023. Patients were stratified by TDTS: ≤7 days (per State Guarantees Program guidelines), 2–4, 5–8, 9–12 weeks, and 3–6, 7–12 months. TSS was calculated using life tables and Kaplan-Meier analysis. The Cox proportional hazards model adjusted for unevenly distributed prognostic factors.
Results. Among 1,440 radically resected GC patients, only 26.9% underwent surgery within the recommended ≤7-day window. The 5-year TSS for the entire cohort was 47.9%. Perioperative chemotherapy in stage II+ GC showed a 2-year TSS of 74.3% (95% CI: 61.0–83.6%) vs. 61.9% without (95% CI: 58.6–65.0%; chi-square (2) 2.98, p = 0.0845). The ≤7-day TDTS group had the lowest 5-year TSS (47.9%) compared to longer delays (56.5–70.5%). In the multiple regression model, after adjusting for stage and confounders, TDTS 8–28, 29–56, and 57–84 days had lower mortality risks vs. ≤7 days: 0.85 (95% CI: 0.66–1.09), 0.70 (95% CI: 0.51–0.96) and 0.75 (95% CI: 0.44–1.28), respectively.
Conclusion. Current clinical practice suggests that the State Guarantees-mandated treatment initiation window may be insufficient to ensure optimal therapeutic outcomes. Prospective studies are needed to validate the safety of deliberate, well-justified delays in surgical intervention and to inform updates to clinical guidelines. Additionally, perioperative chemotherapy appears to improve survival in real-world settings, though further large-scale studies are required to confirm these findings.
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