Individualized adjuvant chemotherapy guided by chemosensitivity test sequential to extended surgery for advanced gastric cancer.
OBJECTIVE
Various adjuvant chemotherapy regimens have been proposed for patients with advanced gastric cancer; however, the majority of these trials failed to show a clear survival benefit over surgery alone. In this study, the feasibility and efficacy of a strategy of extended surgery combined with individualized adjuvant chemotherapy for advanced gastric cancer with serosal invasion and nodal involvement was examined.


METHODS
Sixty-four patients with advanced gastric cancer underwent gastrectomy with extended lymph node dissection. After surgery, a chemosensitivity test by MTT assay, using highly purified tumor cells, was performed, and the patients received individualized adjuvant chemotherapy on the basis of the results of this chemosensitivity test.


RESULTS
Overall survival in the chemosensitivity-guided chemotherapy (CSC) group was significantly better than the standard chemotherapy (SC) and the no-chemotherapy (NC) group (p<0.05). In patients with stage IV disease, the 5-year survival rate was 38.1% in the CSC group and 0% in the SC + NC group, respectively, with a significant difference being observed in the two survival curves (p<0.01). In patients with paraaortic node involvement, survival in the CSC group was significantly better than that in the SC + NC group (p<0.01). On the other hand, in patients without paraaortic node involvement, no survival difference was observed between the two groups.


CONCLUSIONS
The strategy of extended surgery combined with individualized adjuvant chemotherapy offers a favorable survival outcome for advanced gastric cancer patients with serosal invasion and nodal involvement.
Iwahashi
Makoto
M
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Nakamori
Mikihito
M
Nakamura
Masaki
M
Noguchi
Kohei
K
Ueda
Kentaro
K
Nakatani
Yoshihiro
Y
Ojima
Toshiyasu
T
Ishida
Koichiro
K
Naka
Teiji
T
Yamaue
Hiroki
H
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004354:Drug Screening Assays, Antitumor; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage / Q000627:therapeutic use; D009367:Neoplasm Staging; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D013778:Tetrazolium Salts; D013844:Thiazoles; D014407:Tumor Cells, Cultured
D000970:Antineoplastic Agents; D013778:Tetrazolium Salts; D013844:Thiazoles; D016685:Mitomycin; D004317:Doxorubicin; C022616:thiazolyl blue; D002945:Cisplatin; D005472:Fluorouracil