Retrospective analysis of adjuvant chemotherapy for curatively resected gastric cancer.
OBJECTIVE
To determine the efficacy of adjuvant chemotherapy for gastric cancer in clinical practice, a retrospective analysis was conducted in a high-volume Chinese cancer center.


METHODS
Between November 1995 and June 2007, a total of 423 gastric or esophagogastric adenocarcinoma patients who did (Arm A, n = 300) or did not (Arm S, n = 123) receive radical gastrectomy followed by postoperative chemotherapy were enrolled in this retrospective analysis. In Arm A, monotherapy(fluoropyrimidines, n = 25), doublet (platinum/fluoropyrimidines, n = 164), or triplet regimens [docetaxel/cisplatin/5FU (DCF), or modified DCF, epirubicin/cisplatin/5FU (ECF) or modified ECF, etoposide/cisplatin/FU, n = 111] were administered. Disease-free survival (DFS) and overall survival (OS) were compared between the two arms. A subgroup analysis was carried out in Arm A. A multivariate analysis of prognostic factors was conducted.


RESULTS
Stage I, II and III cancers accounted for 9.7%, 35.7% and 54.6% of the cases, respectively, according to the American Joint Committee on Cancer (AJCC) staging system, 7(th) edition. Only 178 (42.1%) patients had more than 15 lymph nodes harvested. Hazard ratio estimates for Arm A compared with Arm S were 0.47 (P < 0.001) for OS and 0.59 (P < 0.001) for DFS. The 5-year OS rate was 52% in Arm A vs 36% in Arm S (P = 0.01); the adverse events in Arm A were mild and easily controlled. Ultimately, 73 patients (26.5%) who received doublet or triplet regimens switched to monotherapy with fluoropyrimidines. The OS and DFS did not differ between monotherapy and the combination regimens, however, both were statistically improved in the subgroup of patients who were switched to monotherapy with fluoropyrimidines after doublet or triplet regimens as well as patients who received ≥ 8 cycles of chemotherapy.


CONCLUSIONS
In clinical practice, platinum/fluoropyrimidines with adequate treatment duration is recommended for stage II/III gastric cancer patients according to the 7(th) edition of the AJCC staging system after curative gastrectomy even with limited lymphadenectomy.
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Wei
W
Deng
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Qi-Wei
QW
Wang
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Xiao-Tian
XT
Zhang
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Ming
M
Lu
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Jie
J
Li
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Yan
Y
Li
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Ji-Fang
JF
Gong
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Jun
J
Zhou
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Zhi-Hao
ZH
Lu
Wei Deng, Qi-Wei Wang, Xiao-Tian Zhang, Ming Lu, Jie Li, Yan Li, Ji-Fang Gong, Jun Zhou, Zhi-Hao Lu, Lin Shen, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
Lin
L
Shen
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002681:China; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D018572:Disease-Free Survival; D000077143:Docetaxel; D015251:Epirubicin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil
Adjuvant chemotherapy; Fluoropyrimidine; Gastric cancer; Lymphadenectomy; Platinum