title: Docetaxel, Cisplatin, and 5-Fluorouracil as perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma.
abstract: Docetaxel, cisplatin, and 5-fluorouracil (DCF) significantly improved overall survival in metastatic gastroesophageal adenocarcinoma (GEA). The aim of this study was to assess efficacy of DCF regimen as perioperative chemotherapy compared with surgery alone in patients with resectable GEA. We identified 789 patients who underwent surgery alone and 62 patients who received at least one cycle of DCF regimen consisting of docetaxel (75 mg/m2on day 1), cisplatin (75 mg/m2on day 1), and 5-fluorouracil (750 mg/m2/day on continuous perfusion on days 1 to 5), every 3 weeks. Overall survival was compared using Cox proportional hazards regression model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched-pair analysis. In Cox multivariate analysis weighted by IPTW, DCF group was associated with favorable overall survival (OS) compared with the surgery group (HR = 0.59; 95% CI, 0.45-0.78; P = 0.0003). For the matched-pair analysis (comparing 41 patients for each group with the same baseline characteristics), median OS was 22 months and 57 months for the surgery group and DCF group, respectively (log-rank P = 0.0011). In Cox multivariate analysis, DCF group was associated with favorable OS compared with the surgery group (HR = 0.29; 95% IC, 0.14-0.64; P = 0.0019). In the matched-pair population, major complications (Dindo-Clavien grade 3-5) arose in six patients (14.63%) in the DCF group and seven patients (17.07%) in the surgery group (P = 1). Perioperative DCF chemotherapy is superior to surgery alone in terms of OS. A randomized phase III trial should compare DCF to standard perioperative regimens.
authors.affiliation: Department of Medical Oncology, University Hospital of Besançon, Besançon, France.|Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Fiteni
authors.affiliation: Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Paget-Bailly
authors.affiliation: Lille University Hospital, Department of Digestive Surgery, Lille, France.|FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Messager
authors.affiliation: Department of Medical Oncology, University Hospital of Besançon, Besançon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: N'Guyen
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Lakkis
authors.affiliation: Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mathieu
authors.affiliation: Department of Surgery, Nord Franche Comté Hospital, Montbeliard, France.
authors.forename: Najib
authors.initials: N
authors.lastname: Lamfichekh
authors.affiliation: Department of Surgery, Nord Franche Comté Hospital, Belfort, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Picard
authors.affiliation: Department of Oncology and Radiotherapy, Nord Franche Comté Hospital, Montbeliard, France.
authors.forename: Bilell
authors.initials: B
authors.lastname: Benzidane
authors.affiliation: Department of Gastroenterology, Hospital of Vesoul, Vesoul, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Cléau
authors.affiliation: Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.|University of Franche-Comté, Besançon, EA 3181, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bonnetain
authors.affiliation: Department of Medical Oncology, University Hospital of Besançon, Besançon, France.|Unit 1098, INSERM, University of Franche-Comté, Besançon, France.|Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Borg
authors.affiliation: Lille University Hospital, Department of Digestive Surgery, Lille, France.|FREGAT (French Esophageal and Gastric Tumour) working group, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Department of Medical Oncology, University Hospital of Besançon, Besançon, France.|Unit 1098, INSERM, University of Franche-Comté, Besançon, France.|Clinical Investigational Center, University Hospital of Besançon, CIC-1431, France.
authors.forename: Stefano
authors.initials: S
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019990:Perioperative Care; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil
keywords: Chemotherapy; docetaxel; gastric cancer; neoadjuvant; surgery