title: Body weight loss after surgery is an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer.
abstract: BACKGROUND
  Compliance of S-1 adjuvant chemotherapy is not high. The aim of the present study is to clarify risk factors for continuation of S-1 after gastrectomy.
  
  
  METHODS
  This retrospective study selected patients who underwent curative D2 surgery for gastric cancer, were diagnosed with stage 2/3 disease, creatinine clearance more than 60 ml/min, and received adjuvant S-1 at our institution between June of 2002 and December of 2011. Time to S-1 treatment failure (TTF) was calculated.
  
  
  RESULTS
  A total of 103 patients were selected for the present study. When TTF curve stratified by each clinical factor was compared by the log-rank test, body weight loss (BWL) of 15 % was regarded as a critical point. Both univariate and multivariate Cox proportional hazard analyses demonstrated that BWL was the significant independent risk factor. Moreover, BWL remained a significant factor in both the univariate and multivariate analyses in the subset excluding 8 patients who discontinued S-1 because of recurrence. The 6-month continuation rate was 66.4 % in the patients with BWL < 15 and 36.4 % in patients with BWL ≥ 15 % (P = .017).
  
  
  CONCLUSIONS
  BWL was the most important risk factor for the compliance of adjuvant chemotherapy with S-1 in the patients with stage 2/3 gastric cancer who underwent D2 gastrectomy. To improve drug compliance that leads to survival, it is a key to maintain body weight before starting S-1 adjuvant. Our study emphasizes the requirement for adequate studies of perioperative nutritional intervention in patients who receive gastrectomy for advanced gastric cancer.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Junya
authors.initials: J
authors.lastname: Shirai
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Yamada
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.forename: Norio
authors.initials: N
authors.lastname: Yukawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Oshima
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D010094:Oxonic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*; D005641:Tegafur / Q000009:adverse effects / Q000627:therapeutic use*; D015431:Weight Loss
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid