Gastric cancer is the fifth most common malignant tumor worldwide and the fourth leading cause of cancer-related deaths. The prognosis of gastric cancer patients after surgery alone is poor, with most patients experiencing recurrence within two years post-treatment. The CRITICS trial compared the efficacy of postoperative chemotherapy versus chemoradiotherapy in gastric cancer patients who underwent D2 lymphadenectomy.

Evaluating health-related quality of life (HRQoL) in clinical trials has become increasingly important as it addresses treatment outcomes from the patient's perspective. The primary objective of this study was to assess the impact of neoadjuvant chemotherapy followed by chemotherapy and chemoradiotherapy (CRT) after extended (D2) lymphadenectomy on HRQoL in the CRITICS trial. It also evaluated the potential prognostic significance of pretreatment HRQoL on event-free survival (EFS) and overall survival (OS).

Patients in the CRITICS trial were required to complete HRQOL questionnaires at baseline, after preoperative chemotherapy, after surgery, following postoperative chemotherapy or CRT, and at the 12-month follow-up. This analysis included patients who completed at least one evaluable questionnaire (645/788). Primary endpoints included dysphagia, pain, physical function, fatigue, and the overall score of the Quality of Life Questionnaire-Core 30.

After postoperative (chemoradiation) therapy, compared to the radiation therapy group, the chemotherapy group showed significantly improved physical function (p=0.02) and less dysphagia (p=0.01). At baseline, poor social functioning (hazard ratio [HR] 2.20, p=0.001), nausea (HR 1.89, p<0.001), worse WHO performance status (HR 1.55, p=0.007), and histologic subtypes (diffuse type vs. intestinal type: HR 1.94, p<0.001; mixed type vs. intestinal type: HR 2.35, p=0.003) were all significantly associated with worse event-free survival and overall survival in patients.

In summary, within the CRITICS trial, patients in the chemotherapy group showed significant improvement in postoperative physiological function and notable alleviation of dysphagia compared to those in the chemoradiotherapy group. Additionally, baseline quality of life was significantly correlated with survival outcomes post-treatment.