S Kim1, S Paget-Bailly2, M Messager3, T Nguyen4, P Mathieu5, N Lamfichekh6, F Fein7, S Fratté8, D Cléau9, Z Lakkis5, M Jary10, N Sakek11, M Jacquin12, A Foubert2, F Bonnetain13, C Mariette14, F Fiteni15, C Borg16. 1. Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France; INSERM, Unit 1098, University of Franche-Comté, Besançon, France. Electronic address: chkim@chu-besancon.fr. 2. Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. 3. Lille University Hospital, Department of Digestive Surgery, Lille, France. 4. Department of Medical Oncology, University Hospital of Besançon, Besançon, France. 5. Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France. 6. Department of Surgery, Nord Franche Comté Hospital, Montbéliard, France. 7. Department of Gastroenterology, University Hospital of Besançon, Besançon, France. 8. Department of Gastroenterology, Nord Franche Comté Hospital, Belfort, France. 9. Department of Gastroenterology, Hospital of Vesoul, Vesoul, France. 10. Department of Medical Oncology, University Hospital of Besançon, Besançon, France; INSERM, Unit 1098, University of Franche-Comté, Besançon, France. 11. Department of Oncology and Radiotherapy, Nord Franche Comté Hospital, Montbéliard, France. 12. Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France. 13. Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France; EA 3181, University of Franche-Comté, Besançon, France. 14. Lille University Hospital, Department of Digestive Surgery, Lille, France; FREGAT, French Esophageal and Gastric Tumor Working Group, France. 15. Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France. 16. Department of Medical Oncology, University Hospital of Besançon, Besançon, France; Clinical Investigational Center, CIC-1431, University Hospital of Besançon, France; INSERM, Unit 1098, University of Franche-Comté, Besançon, France.
Abstract
BACKGROUND: Even though the perioperative chemotherapy improves the overall survival (OS) compared to surgery alone in patients with a resectable gastroesophageal adenocarcinoma (GEA), prognosis of these patients remains poor. Docetaxel (D), cisplatin (C), and 5-fluorouracil (F) regimen improves OS compared to CF among patients with advanced GEA. We evaluated the potential interest of a perioperative DCF regimen, compared to standard (S) regimens, in resectable GEA patients. METHODS: We identified 459 patients treated with preoperative DCF or S regimens. The primary endpoint was OS. Propensity scores were estimated with a logistic regression model in which all baseline covariates were included. We then used two methods to take PS into account and thus make DCF and S patients comparable. OS analyses were performed with Kaplan-Meier and Cox models in propensity score matched samples, and inverse probability of treatment weighted (IPTW) samples. RESULTS: In the propensity score matched sample, the p-value from the log rank test for OS was 0.0961, and the 3-year OS rate was 73% and 55% in DCF and S groups, respectively. The multivariate Cox regression underlined a Hazard Ratio of 0.55 (95% CI 0.27-1.13) for DCF patients compared to S patients. The results from IPTW analyses showed that DCF was significantly and independently associated with OS (HR = 0.52; 95% CI 0.40-0.69). CONCLUSIONS: In this retrospective multicenter, hypothesis-generating study, the propensity score analyses underlined encouraging results in favor of DCF compared to S regimens regarding OS. This promising result should be validated in a phase-3 trial.
BACKGROUND: Even though the perioperative chemotherapy improves the overall survival (OS) compared to surgery alone in patients with a resectable gastroesophageal adenocarcinoma (GEA), prognosis of these patients remains poor. Docetaxel (D), cisplatin (C), and 5-fluorouracil (F) regimen improves OS compared to CF among patients with advanced GEA. We evaluated the potential interest of a perioperative DCF regimen, compared to standard (S) regimens, in resectable GEA patients. METHODS: We identified 459 patients treated with preoperative DCF or S regimens. The primary endpoint was OS. Propensity scores were estimated with a logistic regression model in which all baseline covariates were included. We then used two methods to take PS into account and thus make DCF and S patients comparable. OS analyses were performed with Kaplan-Meier and Cox models in propensity score matched samples, and inverse probability of treatment weighted (IPTW) samples. RESULTS: In the propensity score matched sample, the p-value from the log rank test for OS was 0.0961, and the 3-year OS rate was 73% and 55% in DCF and S groups, respectively. The multivariate Cox regression underlined a Hazard Ratio of 0.55 (95% CI 0.27-1.13) for DCFpatients compared to S patients. The results from IPTW analyses showed that DCF was significantly and independently associated with OS (HR = 0.52; 95% CI 0.40-0.69). CONCLUSIONS: In this retrospective multicenter, hypothesis-generating study, the propensity score analyses underlined encouraging results in favor of DCF compared to S regimens regarding OS. This promising result should be validated in a phase-3 trial.
Authors: Alexander P Stark; Mariela M Blum; Yi-Ju Chiang; Prajnan Das; Bruce D Minsky; Jeannelyn S Estrella; Jaffer A Ajani; Brian D Badgwell; Paul Mansfield; Naruhiko Ikoma Journal: J Gastric Cancer Date: 2020-09-17 Impact factor: 3.720