title: Clinical efficacy of protein-bound polysaccharide K in patients with gastric cancer undergoing chemotherapy with an oral fluoropyrimidine (S-1).
abstract: BACKGROUND
  The aim of the present study was to evaluate the clinical significance of protein-bound polysaccharide K (PSK) in patients with primary gastric cancer who were being treated with an oral fluoropyrimidine (S-1).
  
  
  METHODS
  Clinical reports of 190 gastric cancer patients treated with S-1 chemotherapy, with or without PSK, at Kochi Medical School between 2007 and 2012 were investigated retrospectively to analyze survival. The neutrophil:lymphocyte ratio (NLR) was also evaluated as indicator of the immunoenhancing effect of PSK.
  
  
  RESULTS
  Overall survival was significantly longer in patients treated with S-1 + PSK than in those given S-1 alone (hazard ratio for death, 0.608; 95% confidence interval 0.375-0.985; P = 0.041). Furthermore, there was a tendency for changes in the NLR during chemotherapy to be lower in the S-1 + PSK group than in the S-1 group, but the difference did not reach statistical significance (P = 0.054). When patients were divided into groups based on preoperative NLR (i.e. <2.5 and ≥2.5), the mean (±SEM) NLR 1 month after the beginning of chemotherapy in the NLR ≥2.5 subgroup was significantly lower in patients treated with S-1 + PSK rather than S-1 alone (1.7 ± 0.7 vs. 3.3 ± 4.1, respectively; P = 0.043).
  
  
  CONCLUSIONS
  Immunochemotherapy using PSK improves the survival of patients with advanced gastric cancer. The NLR may be a useful biomarker for evaluating prognosis in these patients.
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan. Electronic address: tsutomun@kochi-u.ac.jp.
authors.forename: T
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Fukudome
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Munekage
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Munekage
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shiga
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Maeda
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005656:Fungal Proteins / Q000008:administration & dosage / Q000276:immunology; D006801:Humans; D007167:Immunotherapy; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010094:Oxonic Acid / Q000008:administration & dosage; D011134:Polysaccharides / Q000008:administration & dosage / Q000276:immunology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D015996:Survival Rate; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; D005656:Fungal Proteins; D011134:Polysaccharides; C494124:protein-bound polysaccharide K, Basidiomycetes; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid
keywords: Gastric cancer; Immunochemotherapy; Neutrophil to lymphocyte ratio; Oral fluorouracil anticancer drug; Protein-bound polysaccharide-K