title: Proper timing of adjuvant chemotherapy affects survival in patients with stage 2 and 3 gastric cancer.
abstract: BACKGROUND
  Adjuvant chemotherapy improves survival in patients with gastric cancer. However, the relationship between the timing of adjuvant chemotherapy and survival has not been investigated.
  
  
  METHODS
  Patients with D2-resected stage 2 and 3 gastric cancer that received adjuvant chemotherapy from 2005 to 2011 at Yonsei University Health System were included. The patients were grouped according to intervals between surgery and adjuvant chemotherapy.
  
  
  RESULTS
  Among 840 patients, the interval from surgery to the start of adjuvant therapy was less than 4 weeks in 337 (40.1 %) patients (early group), 4-8 weeks in 467 (55.6 %) patients (intermediate group), and more than 8 weeks in 36 (4.3 %) patients (late group). The 5-year RFS was 55.7 % in the early group, 54.4 % in the intermediate group, and 43.6 % in the late group (p = 0.076). The corresponding 5-year OS rates were 63.4, 62.8, and 51.7 % (p = 0.037).
  
  
  CONCLUSIONS
  There is insufficient evidence to suggest starting adjuvant chemotherapy within 4 weeks after surgery for patients with D2 resected stage 2 and 3 gastric cancer. However, delayed treatment of adjuvant chemotherapy after 8 weeks showed worse survival outcomes than early and intermediate treatment initiation, suggesting that adjuvant chemotherapy should be considered start within 8 weeks after radical resection.
authors: Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea.
authors: Hyung Soon
authors: HS
authors: Park
authors: Minkyu
authors: M
authors: Jung
authors: Hyo Song
authors: HS
authors: Kim
authors: Hyoung-Il
authors: HI
authors: Kim
authors: Ji Yeong
authors: JY
authors: An
authors: Jae-Ho
authors: JH
authors: Cheong
authors: Woo Jin
authors: WJ
authors: Hyung
authors: Sung Hoon
authors: SH
authors: Noh
authors: Yong Il
authors: YI
authors: Kim
authors: Hyun Cheol
authors: HC
authors: Chung
authors: Sun Young
authors: SY
authors: Rha
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D013997:Time Factors