title: Effect of S-1 adjuvant chemotherapy on survival following recurrence and efficacy of first-line treatment in recurrent gastric cancer.
abstract: BACKGROUND
  As S-1 monotherapy has recently become the standard adjuvant regimen for stage II-III gastric cancer patients after curative gastrectomy in Japan, the question whether adjuvant S-1 affects the subsequent clinical course of relapsed patients has attracted great concern.
  
  
  METHODS
  We retrospectively evaluated the effect of adjuvant S-1 on survival following recurrence and efficacy of first-line treatment in patients with recurrent gastric cancer after curative gastrectomy. A total of 89 patients were evaluated. Thirty patients received adjuvant S-1 (cohort A), 10 patients were given adjuvant chemotherapy with other oral 5-FU agents (cohort B) and 49 patients received no adjuvant chemotherapy (cohort C).
  
  
  RESULTS
  Median survival time following recurrence was 287 days in cohort A, 451 days in B and 547 days in C, with a significant difference between A and C (p = 0.0034). Response rates of the first-line chemotherapy after recurrence were 6.7, 30.0 and 42.9% in cohorts A, B and C, respectively, with a significant difference between A and C (p = 0.0007). On multivariate analysis, S-1 adjuvant chemotherapy was independently associated with poor prognosis after recurrence (hazard ratio 2.64).
  
  
  CONCLUSIONS
  S-1 adjuvant chemotherapy significantly reduced survival and response to first-line chemotherapy following recurrence in patients with recurrent gastric cancer.
authors.affiliation: Department of Gastroenterology, National Osaka Medical Center, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Shoichi
authors.initials: S
authors.lastname: Nakazuru
authors.forename: Eiji
authors.initials: E
authors.lastname: Mita
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D004338:Drug Combinations; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D005472:Fluorouracil