title: Early initiation of fluorouracil-based adjuvant chemotherapy improves survival in patients with resectable gastric cancer.
abstract: OBJECTIVE
  Several clinical trials have suggested that adjuvant chemotherapy improves the survival of patients with resected gastric cancer, but the optimal time at which to initiate post-operative adjuvant chemotherapy has not been studied. This study investigated the association between time to adjuvant chemotherapy and survival in gastric cancer.
  
  
  METHODS
  We retrospectively identified 266 patients with stage IB-IIIC gastric cancer who received fluorouracil-based adjuvant chemotherapy after radical gastrectomy. Overall survival (OS) was compared between patients grouped according to time from surgery to adjuvant chemotherapy (<45 and ≥45 days). The Cox proportional hazards model was used to analyze the effects of time to initiation of chemotherapy and other clinical covariates on survival.
  
  
  RESULTS
  Of 266 patients, 141 (53%) started adjuvant chemotherapy within 45 days after surgery and 125 (47%) started adjuvant chemotherapy more than 45 days after surgery. The 3-year OS rates were 81.2 and 65.8% for patients starting chemotherapy within 45 days and after 45 days, respectively (p=0.006). Multivariate analysis identified early initiation of adjuvant chemotherapy, completion of the planned chemotherapy, and early-stage disease as favorable prognostic factors in terms of OS (p<0.05). Subgroup analysis suggested that starting chemotherapy within 45 days after surgery was associated with significant OS benefit compared with initiation of chemotherapy after 45 days from surgery in most subgroups.
  
  
  CONCLUSIONS
  This retrospective analysis suggests that delaying adjuvant chemotherapy for longer than 45 days after surgery may be associated with poorer survival in patients with resected gastric cancer.
authors.affiliation: Department of Medical Oncology, The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang 110001, China.
authors.forename: Jing-Lei
authors.initials: JL
authors.lastname: Qu
authors.forename: Xiu-Juan
authors.initials: XJ
authors.lastname: Qu
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Jing-Dong
authors.initials: JD
authors.lastname: Zhang
authors.forename: Yue-E
authors.initials: YE
authors.lastname: Teng
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Zhao
authors.forename: Ping
authors.initials: P
authors.lastname: Yu
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Dong-Yang
authors.initials: DY
authors.lastname: Li
authors.forename: Yun-Peng
authors.initials: YP
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage* / Q000009:adverse effects; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil