Koki Nakanishi1, Mitsuro Kanda2, Seiji Ito3, Yoshinari Mochizuki4, Hitoshi Teramoto5, Kiyoshi Ishigure6, Toshifumi Murai7, Takahiro Asada8, Akiharu Ishiyama9, Hidenobu Matsushita10, Chie Tanaka1, Daisuke Kobayashi1, Michitaka Fujiwara1, Kenta Murotani11, Yasuhiro Kodera1. 1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. m-kanda@med.nagoya-u.ac.jp. 3. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. 4. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan. 5. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan. 6. Department of Surgery, Konan Kosei Hospital, Konan, Japan. 7. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 8. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 9. Department of Surgery, Okazaki City Hospital, Okazaki, Japan. 10. Department of Surgery, Tosei General Hospital, Seto, Japan. 11. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan.
Abstract
BACKGROUND: This study aimed to evaluate whether the timing of initiating postoperative chemotherapy with S-1 monotherapy affects gastric cancer patients' prognosis. METHODS: A multi-institution dataset identified patients with pStage II or III gastric cancer who received S-1 monotherapy for over 6 months after curative resection between 2010 and 2014. Patients were divided into three groups based on the timing of S-1 monotherapy initiation. Prognostic factors for relapse-free survival (RFS) were investigated. RESULTS: We classified 401 patients into groups as follows: S-1 administered within 6 weeks (n = 247), between 6 and 8 weeks (n = 95), and after 8 weeks (n = 59). The RFS times were not significantly different in the within 6 weeks group and the between 6 and 8 weeks group, but the after 8 weeks group had a shorter RFS time compared with the other two groups (within 6 weeks group vs. after 8 weeks group; P = 0.0044). By disease stage, this trend was the same. The multivariable analysis showed that a larger tumor size (≥ 50 mm), pStage III, and the after 8 weeks group were independent prognostic factors for RFS (after 8 weeks group: hazard ratio, 2.05; P = 0.0069). The prevalence of hematogenous metastasis as the initial recurrence site increased by delayed initiation of S-1. A forest plot revealed that delayed administration after 8 weeks was associated with a greater risk of recurrence in most subgroups. CONCLUSIONS: Postoperative chemotherapy with S-1 monotherapy for gastric cancer is recommended to begin within 8 weeks after surgery.
BACKGROUND: This study aimed to evaluate whether the timing of initiating postoperative chemotherapy with S-1 monotherapy affects gastric cancerpatients' prognosis. METHODS: A multi-institution dataset identified patients with pStage II or III gastric cancer who received S-1 monotherapy for over 6 months after curative resection between 2010 and 2014. Patients were divided into three groups based on the timing of S-1 monotherapy initiation. Prognostic factors for relapse-free survival (RFS) were investigated. RESULTS: We classified 401 patients into groups as follows: S-1 administered within 6 weeks (n = 247), between 6 and 8 weeks (n = 95), and after 8 weeks (n = 59). The RFS times were not significantly different in the within 6 weeks group and the between 6 and 8 weeks group, but the after 8 weeks group had a shorter RFS time compared with the other two groups (within 6 weeks group vs. after 8 weeks group; P = 0.0044). By disease stage, this trend was the same. The multivariable analysis showed that a larger tumor size (≥ 50 mm), pStage III, and the after 8 weeks group were independent prognostic factors for RFS (after 8 weeks group: hazard ratio, 2.05; P = 0.0069). The prevalence of hematogenous metastasis as the initial recurrence site increased by delayed initiation of S-1. A forest plot revealed that delayed administration after 8 weeks was associated with a greater risk of recurrence in most subgroups. CONCLUSIONS: Postoperative chemotherapy with S-1 monotherapy for gastric cancer is recommended to begin within 8 weeks after surgery.
Entities:
Keywords:
Gastric cancer; Postoperative chemotherapy; Prognosis; S-1; Timing of initiation
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396