{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T02:44:25Z","timestamp":1774579465823,"version":"3.50.1"},"reference-count":32,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"9","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Precis Oncol"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Uncertainty persists regarding the optimal interval between D2 gastrectomy and initiation of adjuvant chemotherapy (AC) for stage II to III gastric cancer (GC). We investigated whether delaying treatment beyond 6 weeks compromises overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS<\/jats:title>\n                    <jats:p>Using multicenter observational data (2010-2022), we emulated a pragmatic noninferiority target trial to compare AC initiation at \u22646 versus 7-12 weeks postgastrectomy. Eligible patients had received curative-intent surgery for stage II to III GC. The AC regimen comprised platinum-based agents plus fluoropyrimidines. The primary end point was 5-year all-cause mortality from surgery to death or administrative censoring (30 June 2025). The Clone-censor-weighting approach was used, and inverse probability weighting achieved balance across baseline and postoperative time-varying covariates (standardized mean difference &lt;0.1). Weighted pooled logistic regression estimated cumulative mortality; risk differences (RDs) and risk ratios (RRs) were computed from 500 bootstrap samples. The prespecified noninferiority margin was an absolute 10% increase in 5-year mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULT<\/jats:title>\n                    <jats:p>Among 1,637 eligible patients, 35.9% initiated AC within 6 weeks (median 37 days), whereas 17.5% began between 7 and 12 weeks postoperatively. Delayed initiation (7-12 weeks) met the noninferiority criterion: the absolute RD in 5-year mortality was \u20130.52% (95% CI, \u20137.95 to 7.41), with the upper confidence limit below the 10% margin. The noninferiority finding was robust to weight trimming and to alternative imputation strategies. No significant difference in mortality was observed across clinically relevant subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Initiating AC 7-12 weeks after D2 gastrectomy appeared to be noninferior to initiation within 6 weeks with respect to 5-year mortality in stage II to III GC; however, residual confounding cannot be excluded and the findings require validation in further studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/po-25-00664","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T20:57:16Z","timestamp":1766091436000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Timing of Adjuvant Chemotherapy After Gastrectomy in Patients With Stage II to III Gastric Cancer: A Target Trial Emulation 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