Postoperative weight loss leads to poor survival through poor S-1 efficacy in patients with stage II/III gastric cancer.
OBJECTIVE
We previously demonstrated that body weight loss (BWL) at one month after gastrectomy, a common finding after surgery for gastric cancer, was an independent risk factor for the continuation of adjuvant chemotherapy with S-1. However, it is unclear whether BWL after gastrectomy leads to poor survival through poor compliance to adjuvant chemotherapy with S-1.


METHODS
We conducted this follow-up study in the same cohort as our previous study. Overall survival (OS) and recurrence-free survival (RFS) were examined in 103 patients who underwent curative D2 surgery and were pathologically diagnosed with stage II or III gastric cancer, and who received postoperative adjuvant chemotherapy with S-1 between June 2002 and December 2011.


RESULTS
The median follow-up period was 64.3 months. The 5-year OS rate in the patients with a BWL of <15% was 59.9%, while that in the patients with a BWL of ≥15% was 36.4% (p = 0.004). Univariate and multivariate analyses for OS demonstrated that pathological T factor and BWL were significant risk factors. On the other hand, the 5-year RFS rate was 56.4% in the BWL <15% group and 36.4% in the BWL ≥15% group (p = 0.016), while univariate and multivariate analyses for RFS demonstrated that BWL was a marginally significant risk factor.


CONCLUSIONS
Severe postoperative BWL, which is closely related with poor S-1 compliance, is an important risk factor for survival. It merits testing if preventing BWL improves survival of gastric cancer patients who receive S-1 adjuvant chemotherapy.
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Toru
T
Aoyama
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Tsutomu
T
Sato
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Yukio
Y
Maezawa
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Kazuki
K
Kano
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Tsutomu
T
Hayashi
Department of Surgery, Yokohama City University, Yokohama, Japan.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Takanobu
T
Yamada
Department of Surgery, Yokohama City University, Yokohama, Japan.
Norio
N
Yukawa
Department of Surgery, Yokohama City University, Yokohama, Japan.
Takashi
T
Oshima
Department of Surgery, Yokohama City University, Yokohama, Japan.
Yasushi
Y
Rino
Department of Surgery, Yokohama City University, Yokohama, Japan.
Munetaka
M
Masuda
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Takashi
T
Ogata
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Haruhiko
H
Cho
Department of Surgery, Yokohama City University, Yokohama, Japan. yoshikawat@kcch.jp.|Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan. yoshikawat@kcch.jp.
Takaki
T
Yoshikawa
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010094:Oxonic Acid / Q000627:therapeutic use*; D011184:Postoperative Period; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D015996:Survival Rate; D005641:Tegafur / Q000627:therapeutic use*; D016896:Treatment Outcome; D015431:Weight Loss
D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid
Adjuvant chemotherapy; Body weight loss; Gastric cancer; Overall survival