Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Purpose: Various adjuvant chemotherapies have been introduced for gastric cancer patients after gastrectomy with D2 lymph node dissection. Although the mainstream regimen of adjuvant chemotherapy in Korea includes S-1 monotherapy (TS-1) and capecitabine with oxaliplatin (XELOX), few studies have compared the long-term efficacies of these 2 regimens. Methods: Between January 2010 and June 2017, 2021 patients were diagnosed with gastric cancer and underwent curative resection with adjuvant chemotherapy at our institution. Of 1461 patients with stage IB-III gastric cancer, 825 received TS-1 and 636 received XELOX as adjuvant chemotherapy. We retrospectively reviewed their medical records and analyzed the postoperative 5-year overall survival (OS) and disease-free survival (DFS) of these 2 groups. Results: The patients in the XELOX group had more advanced stage of cancer than the TS-1 group (stages III and II: 56.6% and 43.1%, respectively, in XELOX and 35.3% and 57.0% in TS-1; P < .001). The DFS did not differ significantly between the 2 study groups at any pathologic stage. The OS differed significantly only at pathologic stages IIA ( P = .024) and IIB ( P = .015). In a multivariate analysis of stage II patients, type of regimen was an independent prognostic factor of OS (XELOX vs TS-1; hazard ratio: 0.47, 95% confidence interval: 0.25-0.89, P = .021). Conclusion: There were similar long-term efficacies between these 2 regimens in advanced gastric cancer patients who underwent curative surgery. However, the XELOX regimen might be favorable for OS of stage II patients.

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Prognostic Indicators in Stage IV Surgically Treated Gastric Cancer Patients: A Retrospective Multi-Institutional Study

Digestive Surgery ◽

10.1159/000488775 ◽

2018 ◽

Vol 36 (4) ◽

pp. 331-339

Author(s):

Alberto Biondi ◽

Domenico D’Ugo ◽

Ferdinando Cananzi ◽

Stefano Rausei ◽

Federico Sicoli ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Residual Disease ◽

Stage Iv ◽

Long Term Results ◽

Stage Iv Gastric Cancer ◽

Short And Long Term ◽

Gastric Cancer Patients

Introduction: The role of gastric resection in treating metastatic gastric adenocarcinoma is controversial. In the present study, we reviewed the short- and long-term outcomes of stage IV patients undergoing surgery. Methods: A retrospective review was conducted that assessed patients undergoing elective surgery for incurable gastric carcinoma. Short- and long-term results were evaluated. Results: A total of 122 stage IV gastric cancer patients were assessed. Postoperative mortality was 5.7%, and the overall rate of complications was 35.2%. The overall survival rate at 1 and 3 years was 58 and 19% respectively; the median survival was 14 months. Improved survival was observed for the factors age less than 60 years (p = 0.015), site of metastases (p = 0.022), extended lymph node dissection (p = 0.044), absence of residual disease after surgery (p = 0.001), and administration of adjuvant chemotherapy (p = 0.016). Multivariate analysis showed that residual disease and adjuvant chemotherapy were independent prognostic factors. Conclusions: The results of this study suggest that surgery combined with systemic chemotherapy in selected patients with stage IV gastric cancer can improve survival.

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Increasing Nodal Ratio is a Poor Prognostic Factor for Survival in Stage III-IV (M0) Gastric Cancer Patients Who Received Curative Surgery Followed by Adjuvant Chemotherapy: A Retrospective Study

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyq215 ◽

2010 ◽

Vol 41 (2) ◽

pp. 245-252 ◽

Cited By ~ 5

Author(s):

J.-S. Kim ◽

M.-A. Kim ◽

D.-Y. Oh ◽

S.-H. Lee ◽

D.-W. Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Retrospective Study ◽

Adjuvant Chemotherapy ◽

Prognostic Factor ◽

Cancer Patients ◽

Stage Iii ◽

Curative Surgery ◽

Poor Prognostic Factor ◽

Nodal Ratio ◽

Gastric Cancer Patients

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Docetaxel plus FOLFOX4 compared with FOLFOX4 as adjuvant chemotherapy for gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.181 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 181-181

Author(s):

Chun-Xia Du ◽

Xiao-Yan Liu ◽

Hong-Gang Zhang ◽

Ai-Ping Zhou

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Survival Rates ◽

Subtotal Gastrectomy ◽

Disease Free Survival ◽

Adjuvant Radiation ◽

Ptnm Stage ◽

Gastric Cancer Patients

181 Background: To compare the efficacy of docetaxel plus FOLFOX4 to FOLFOX4 as adjuvant chemotherapy for gastric cancer patients. Methods: 320 patients with stage IB-IV (M0) gastric cancer were enrolled into the retrospective study. All patients received a total or subtotal gastrectomy with at least D1 lymph nodes dissection. 193 patients received FOLFOX4 as adjuvant chemotherapy. 127 patients received biweekly docetaxel plus FOLFOX4 (DOF regimen) as adjuvant chemotherapy. Docetaxel was administered at 40 mg/m2 on day 1, followed by FOLFOX4 regimen. Both of the regimens were repeated every 2 weeks for a maximum of 12 cycles. Results: In comparison with patients in FOLFOX4 group, patients in DOF group were relatively younger (p=.001), with more advanced disease in pN stage (p=.035) and pTNM stage (p=.031), received more cycles of adjuvant chemotherapy (p=.004), and had a higher percentage of adjuvant radiation (p =.002). After adjustment of unbalanced variables as mentioned above, no statistical difference was observed between DOF group and FOLFOX4 group in terms of 3-year disease-free survival (54% vs 69%, p = 0.100, HR 1.362, 95% CI (0.943-1.967)) and 3-year overall survival(70% vs 72%, p = 0.810, HR 1.049, 95% CI (0.711-1.548)). Stratified analysis according to clinicopathologic characters showed that there were almost no statistical differences of 3-year overall survival rates between two groups, except the primary site (middle 1/3) (p =.025) and pTNM stage (IIb stage) (p =.035) in favor of FOLFOX4 group. The incidences of grade 3/4 adverse events were obviously higher in DOF group than in FOLFOX4 group,including decreased appetite (18.1% V 10.4%, P = 0.046), diarrhea (4.7% V 0%, p=0.004 ), hypersensitivity reactions to oxaliplatin (3.1% V 0%, p=0.024) and neutropenia (47.3% V 31.6%, p=0.004). Conclusions: Compared to FOLFOX4 regimen, adjuvant docetaxel plus FOLFOX4 did not show significant survival advantages in gastric cancer patients. However, a more serious toxicity profile was observed in docetaxel plus FOLFOX4 arm. Further studies are needed to decide whether triplet regimen is appropriate as adjuvant chemotherapy of gastric cancer.

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Neutrophil-to-lymphocyte ratio (NLR) to predict the short-term and long-term outcomes of gastric cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15560 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15560-e15560

Author(s):

Ryoichi Miyamoto ◽

Satoshi Inagawa ◽

Naoki Sano ◽

Sosuke Tadano ◽

Masayoshi Yamamoto

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Predictive Value ◽

Disease Free Survival ◽

Perioperative Outcomes ◽

Survival Times ◽

Long Term Outcomes ◽

Short Term ◽

Gastric Cancer Patients

e15560 Background: Preoperative NLR was well known as highly repeatable, cost-effective and widely available long-term postoperative prognostic marker of gastric cancer patients. However, the utility of preoperative NLR to predict short-term outcomes in gastric cancer patients remains unclear. In this study, we addressed whether the preoperative NLR is a predictive value of short-term outcome in gastric cancer patients. Methods: We retrospectively evaluated 154 consecutive gastric cancer patients. Mean NLR was calculated, and 3.5 was set as cut-off value. The patient characteristics and perioperative outcomes were respectively compared. In addition, median survival times (MSTs) were also compared. In terms of stage II/III (UICC 7th) gastric cancer patients, median disease-free survival times (MDFSTs) were compared between the two groups. Results: The patients were then divided into two groups: low-NLR group (n = 110) and high-NLR group (n = 44). Among low-NLR group and high-NLR group, significant differences were respectively observed in preoperative symptoms [56 (51%) vs. 31 (70%); p = 0.027] and perioperative outcomes including postoperative complications [3 (2.7%) vs. 5 (11.3%); p = 0.015], intraoperative blood loss (158 ± 168 g vs. 232 ± 433 g; p = 0.022), and intraoperative blood transfusion [0 vs. 3 (6.8%); p = 0.042]. MSTs and MDFSTs were significantly differed (812 vs. 594 days; p = 0.04, 848 vs. 475 days; p = 0.03, respectively). Conclusions: The present study indicated that preoperative NLR influenced not only long-term outcomes but also perioperative outcomes in gastric cancer patients. Preoperative NLR is also a useful predictive value of short-term outcomes in gastric cancer patients.

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Immunoscore is a strong predictor of survival in the prognosis of stage II/III gastric cancer patients following 5-FU-based adjuvant chemotherapy

Cancer Immunology Immunotherapy ◽

10.1007/s00262-020-02694-6 ◽

2020 ◽

Author(s):

Sumi Yun ◽

Jiwon Koh ◽

Soo Kyung Nam ◽

Yoonjin Kwak ◽

Sang-Hoon Ahn ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Strong Predictor ◽

Stage Ii ◽

Gastric Cancer Patients

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Postoperation chemotherapy with S1 and docetaxel in curatively resected gastric cancer of stage III (POST trial).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.tps4142 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. TPS4142-TPS4142

Author(s):

Minkyu Jung ◽

Seok Yun Kang ◽

Bong-Seog Kim ◽

Ki Hyang Kim ◽

Kyung Hee Lee ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Cancer Patients ◽

Controlled Trial ◽

Disease Free Survival ◽

Stage Iii ◽

Open Label ◽

Post Trial ◽

Gastric Cancer Patients

TPS4142 Background: Complete surgical resections remains the only chance for cure in patients with gastric cancer, but approximately from 40% to 80% of patients still have recurrences and most patients ultimately die from their disease. The recent adjuvant trials in gastric cancer showed significantly improved survival in patients with adjuvant chemotherapy than those with surgery alone. However, further studies need for the effect of adjuvant chemotherapy following D2 dissected gastric cancer patients, especially in advanced gastric cancer. S-1 is an oral anticancer drug, a prodrug of fluorouracil, very effective in gastric cancer. Docetaxel is the first drug that showed survival benefits when added to the two drugs in advanced gastric cancer patients. And docetaxel is also synergistic anti-cancer effect with S-1 in advanced gastric cancer. Base on this background, the aim of this study is to detect a significant increase in 3 –year disease free survival (DFS) of adjuvant chemotherapy with docetaxel and S-1(DS) relative to those with S-1 and cisplatin (SP) in patients with stage III gastric cancer Methods: This study is an open-label, phase 3, randomized controlled trial, multicenter in South Korea. Patients with stage III (AJCC 7th edition) gastric cancer who had had curative D2 gastrectomy is randomly assigned to receive adjuvant chemotherapy of eight 3-week cycles of intravenous docetaxel (35 mg/m2 on day 1 and 8 of each cycle) plus oral S-1 (35 mg/m2 twice daily on days 1 to 14 of each cycle) for 6 months (DS) or chemotherapy of eight 3-week cycles of oral S1 plus intravenous cisplatin (60 mg/m2). After satisfying the screening criteria, patients have been randomized to the SD or SP arm in a 1:1 ratio. The randomization is stratified by institution and stage of disease (IIIA vs. IIIB vs. IIIC). The each stratum has been randomized by using the method of randomly permuted block. The primary endpoint is 3 year DFS, will analyze by intention to treat. A total of 290 patients will be enrolled, 67 patients have been treated to day, with continuing accrual. The trial is registered at ClinicalTrials.gov (NCT01283217).

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A phase II study to examine the effectiveness of nutritional support with elemental diet for stage II/III gastric cancer patients receiving adjuvant chemotherapy with S-1 (OGSG 1108).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.98 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 98-98

Author(s):

Junji Kawada ◽

Hiroshi Imamura ◽

Jin Matsuyama ◽

Junichi Fukui ◽

Kazuhiro Nishikawa ◽

...

Keyword(s):

Gastric Cancer ◽

Weight Loss ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Nutritional Support ◽

Elemental Diet ◽

Stage Ii ◽

Postoperative Weight Loss ◽

Second Stage ◽

Gastric Cancer Patients

98 Background: Postoperative weight loss after gastrectomy causes deterioration in patient’s quality of life and tolerance for adjuvant chemotherapy in gastric cancer patients. Nutritional support may prevent postoperative weight loss and chemotherapy related adverse effects to improve compliance of adjuvant chemotherapy. Methods: Clinical stage II/III gastric cancer patients received R0 resection were registered in the first stage of the present study. Those patients were qualified and enrolled in the second stage who could intake more than 60% of elemental diet (Elental, 300 kcal/day for 14 days) in the postoperative period and were proven pathological stage II/III. Enrolled patients were planned to receive a total of 300 kcal/day of Elental for 24 weeks and additional courses was permitted up to 365 days. The primary endpoint was compliance of S-1: percent of patients who accomplish S-1 adjuvant for one year with more than 70% relative performance (RP). The secondary endpoints were nutritional parameters (body weight, BMI, s-albumin, s-protein, s-cholesterol), RP of 8 courses of S-1, adverse effects of S-1, RP of Elental and ratio of patients who were enrolled to the second stage. Results: From January 2012 to September 2014, 149 patients were registered in the first stage and 82 patients were enrolled in the second stage: including 50 men; 32 women; median age of 70 years (range, 42-85 years); and performance status were zero in 45 and one in 37 patients. Compliances of S-1 were 60.5% (95%CI: 49.0, 71.2) in 81 eligible patients and 69% (95%CI: 56.9, 79.5) in eligible patients without recurrence. In 81 eligible patients, RP of 8 courses of S-1 was 87.3 % (95%CI: 88.3, 85.9), and the body weight loss was 1.80kg (95%CI: -0.38, 4.48). Grade 3-4 toxicities were neutropenia 12%, anemia 4%, anorexia 4% and diarrhea 4%. Conclusions: Nutritional support for gastric cancer patients receiving adjuvant chemotherapy contributes to increase compliance of S-1 and potential effect on survival may be expected. Clinical trial information: UMIN000006872.

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