Does the treatment concept of advanced gastric cancer require innovation?: Two cases of advanced gastric cancer with distinctively different outcomes.

RATIONALE: With the continuous progress of science and technology, remarkable achievements have been made in the treatment of gastric cancer (GC). In China, the vast majority of GC patients are diagnosed with advanced GC at the time of initial detection. Given its high incidence and mortality rates, GC poses a serious threat to the health of the Chinese population. The selection of appropriate treatment strategies for patients with advanced GC remains a controversial and challenging issue in clinical practice. PATIENT CONCERNS: Two patients diagnosed with advanced GC experienced drastically different prognoses due to the adoption of disparate treatment modalities. DIAGNOSES: One patient, at stage IIIA, another patient at stage IIB. INTERVENTIONS: The stage IIIA patient received neoadjuvant chemotherapy followed by surgical resection, and the stage IIB patient underwent direct surgical resection. OUTCOMES: The patient who received neoadjuvant therapy and surgery has remained free of recurrence so far. In contrast, the direct surgery one unfortunately succumbed to tumor recurrence 1 year after the operation. LESSONS: These 2 patients with the same diagnosis of advanced GC presented strikingly different outcomes, which prompted us to deeply contemplate the optimal treatment approaches for this disease. This paper aims to provide valuable references for the treatment selection of advanced GC.