title: Optimal duration of fluorouracil-based adjuvant chemotherapy for patients with resectable gastric cancer.
abstract: BACKGROUND
  Although several clinical trials have suggested that postoperative adjuvant chemotherapy can improve survival of patients with gastric cancer, the optimal treatment duration has not been studied. This retrospective analysis evaluated the outcomes of patients with gastric cancer treated with six cycles of fluorouracil-based treatment compared with a cohort treated with four or eight cycles.
  
  
  METHODS
  We retrospectively identified 237 patients with stage IB-IIIC gastric cancer who received four, six, or eight cycles of fluorouracil-based adjuvant chemotherapy administered every 3 weeks after radical gastrectomy. The endpoint was overall survival (OS). Factors associated with prognosis were also analyzed.
  
  
  RESULTS
  The estimated 3-year OS rates for the four-, six-, and eight-cycle cohorts were 54.4%, 76.1%, and 68.9%, respectively; and the estimated 5-year OS rates were 41.2%, 74.0%, and 65.8%, respectively. Patients who received six cycles were more likely to have a better OS than those who received four cycles (P = 0.002). Eight cycles failed to show an additional survival benefit (P = 0.454). In the multivariate analysis, the number of chemotherapy cycles was associated with OS independent of clinical covariates (P<0.05). Subgroup analysis suggested that among patients in all age groups examined, male patients, and subgroups of fluorouracil plus oxaliplatin combined chemotherapy, stage III, poor differentiation, and gastrectomy with D2 lymphadenectomy, six cycles of adjuvant chemotherapy were associated with a statistically significant benefit of OS compared with four cycles (P<0.05).
  
  
  CONCLUSIONS
  Six cycles of adjuvant chemotherapy might lead to a favorable outcome for patients with gastric cancer, and two further cycles could not provide an additional clinical benefit.
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Jing-lei
authors.initials: JL
authors.lastname: Qu
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Xiu-Juan
authors.initials: XJ
authors.lastname: Qu
authors.affiliation: Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, China.
authors.forename: Zhi-tu
authors.initials: ZT
authors.lastname: Zhu
authors.affiliation: Department of Medical Oncology, The Fourth Hospital of Anshan, Anshan, China.
authors.forename: Li-zhong
authors.initials: LZ
authors.lastname: Zhou
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Yue-e
authors.initials: YE
authors.lastname: Teng
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Jing-dong
authors.initials: JD
authors.lastname: Zhang
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Ming-fang
authors.initials: MF
authors.lastname: Zhao
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Yu
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China.
authors.forename: Yun-peng
authors.initials: YP
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D005472:Fluorouracil