title: 5-fluorouracil, mitomycin-C, and polysaccharide-K adjuvant chemoimmunotherapy for locally advanced gastric cancer: the prognostic significance of frequent perineural invasion.
abstract: OBJECTIVE
  Although adjuvant chemotherapy has demonstrated small but significant survival benefit in locally advanced gastric cancer in several meta-analyses, optimal chemotherapy regimen remains to be determined.
  
  
  METHODS
  We retrospectively analyzed the survival of 207 gastric cancer patients (stage IB: 19, II: 65, IIIA: 58, IIIB: 28, IV: 37) who underwent 5-fluorouracil (5-FU), mitomycin-C (MMC), and polysaccharide-K (PSK) chemoimmunotherapy (CITX) after curative resection (FM group). The survival of FM group was compared with that of historical control cohort of 103 patients with almost identical stage distribution who received 5-FU and doxorubicin-based chemotherapy (FA group).
  
  
  RESULTS
  Five-year disease-free survival and overall survival (OS) of FM group were 58.7% and 59.1%, respectively. Frequent perineural invasion was significantly associated with poor OS (p = 0.01) in multivariate analysis. There was no statistically significant difference in 5-year OS (59.1% vs. 56.2%, p = 0.637) between FM and FA groups. FM group showed superior 5-year OS (84.4% vs. 67.6%, p = 0.019) compared with FA group in stage IB or II patients without significant difference (p = 0.222) in stage IIIA to IV.
  
  
  CONCLUSIONS
  5-FU, MMC, and PSK CITX is as effective as 5-FU and doxorubicin-based chemotherapy. Moreover, frequent perineural invasion seems to be an important poor prognostic factor.
authors.affiliation: Department of Hematology-Oncology, Ajou University School of Medicine Suwon, Korea.
authors.forename: Jin-Hyuk
authors.initials: JH
authors.lastname: Choi
authors.forename: Young-Bae
authors.initials: YB
authors.lastname: Kim
authors.forename: Ho-Yeong
authors.initials: HY
authors.lastname: Lim
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Park
authors.forename: Hugh Chul
authors.initials: HC
authors.lastname: Kim
authors.forename: Yong Kwan
authors.initials: YK
authors.lastname: Cho
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Han
authors.forename: Myung Wook
authors.initials: MW
authors.lastname: Kim
authors.forename: Hee Jae
authors.initials: HJ
authors.lastname: Joo
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D010525:Peripheral Nerves / Q000473:pathology*; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D000903:Antibiotics, Antineoplastic; D016685:Mitomycin; D005472:Fluorouracil