Adjuvant chemotherapy is an additional option for locally advanced gastric cancer after radical gastrectomy with D2 lymphadenectomy: A retrospective control study
- Adjuvant chemotherapy is an additional option for locally advanced gastric cancer after radical gastrectomy with D2. - Background: This study compared the long-term efficacy of different durations of adjuvant chemotherapy for patients with gastric cancer after radical gastrectomy with D2 lymphadenectomy.. - Methods: We retrospectively identified 428 patients with stage II – III gastric cancer who underwent D2 gastrectomy between 2009 and 2016. - Patients were divided into four groups according to the duration of adjuvant. - chemotherapy, including 0 week (no adjuvant, group A), 20 to 24 weeks (completed 7 – 8 cycles every 3 weeks or 10 – 12 cycles every 2 weeks, group B), and 12 to18 weeks (completed 4 – 6 cycles every 3 weeks or 6 – 9 cycles every 2 weeks, group C), and less than 12 weeks (received up to 3 cycles every 3 weeks or 5 cycles every 2 weeks, group D).. - To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.. - Conclusions: To reduce toxicity and maintain efficacy, XELOX or SOX chemotherapy regimens administered for 4 – 6 cycles every 3 weeks or FOLFOX regimen for 6 – 9 cycles every 2 weeks might be a favorable option for patients with stage II – III gastric cancer after D2 gastrectomy. - Gastric cancer (GC) is one of the most common malig- nancies in humans, ranking fifth in incidence and third in mortality globally. - Therefore, postoperative adjuvant chemotherapy is the main treat- ment [3].. - In our center, in accordance with the Chinese Society of Clinical Oncology clinical guidelines, the recom- mended postoperative adjuvant chemotherapy regimens for patients with stage II – III GC who did not receive preoperative treatment include XELOX, S-1, S-1 and oxaliplatin (SOX, administered every 3 weeks) and FU, oxaliplatin and leucovorin calcium (FOLFOX, adminis- tered every 2 weeks) [8]. - Hence, we conducted a retrospective study of this para- dox in the clinical setting to compare the long-term ef- fects of different durations (four groups) of adjuvant chemotherapy on OS for patients with GC after radical gastrectomy with D2 lymphadenectomy. - (3) prior completion of rad- ical gastrectomy with D2 lymphadenectomy and a post- operative pathological diagnosis of stage II–III gastric cancer. - Qu et al. - [13] con- ducted a retrospective analysis of 237 patients with stage IB–IIIC GC showed that six cycles of FU-based adjuvant chemotherapy (18 weeks) are adequate compared to. - patients did not receive adjuvant chemotherapy (group A), and 342 patients received at least one cycle doublet chemotherapy. - One hundred seventy-five patients com- pleted 7–8 cycles of adjuvant chemotherapy adminis- tered every 3 weeks or 10–12 cycles of chemotherapy administered every 2 weeks (group B). - In terms of age, pairwise comparisons among the four groups revealed significant differences, which suggests that patients’ probability to receive chemotherapy and the duration of adjuvant chemotherapy decreased with increasing age. - In terms of BMI, a significant difference was only found between groups A and B (median: 22.7 versus 23.9, P = 0.008), which suggests that patients with low BMI might be less willing to receive adjuvant chemotherapy than those with high BMI. - Con- cerning tumor length/diameter, we found no association with adjuvant chemotherapy (Table 2).. - The MAGIC, ACTS-GC, and CLASSIC trials have pro- vided high-level evidence of the benefit of adjuvant chemotherapy in GC [5–7]. - 1 Duration and regimens of adjuvant chemotherapy for II-III GC patients. - Variables Total Adjuvant chemotherapy cycles. - 7 – 8 or 10 – 12 cycles (B). - 4 – 6 or 6 – 9 cycles (C). - Not received (A) 7 – 8 or 10 – 12 cycles (B) 4 – 6 or 6 – 9 cycles (C. - 7 – 8 or 10 – 12 cycles (B) <. - 7 – 8 or 10 – 12 cycles (B . - 4–6 or 6–9 cycles (C . - The results sug- gest that shortening the duration of adjuvant chemother- apy to 4–6 cycles administered every 3 weeks or 6–9 cycles administered every 2 weeks (group C) produced similar efficacy as 7–8 cycles administered every 3 weeks or 10–12 cycles administered every 2 weeks (group B).. - Adjuvant Chemotherapy cycles. - 4 – 6 or 6 – 9 cycles (C . - The multivariate analysis confirmed with high statistical sig- nificance the efficacy of complete courses of adjuvant chemotherapy, and, among them, the similar impact of 4–6/6–9 and 7–8/10–12 cycles, resulting in similar HRs vs Group A (0.52 and 0.42, respectively). - We retrospectively analyzed 428 patients with stage II–III GC after D2 gas- trectomy, and the 5-year OS rates for groups B and C were 73.7 and 72.0%, respectively, which were higher than those of patients who completed eight cycles and comparable to those of patients who completed six cy- cles in the study by Qu et al.. - Our results were also com- parable with those of the ACTS-GC study, in which all patients with confirmed stage II–III gastric cancer underwent D2 gastrectomy, and the 5-year OS rate was 71.7% in the S-1 group [6]. - Moreover, the ARTIST trial failed to dem- onstrate that the addition of radiotherapy to postopera- tive adjuvant chemotherapy significantly improved DFS in patients who underwent D2 gastrectomy [19]. - Adjuvant chemotherapy cycles <. - 7 – 8 or 10 – 12 cycles (B lt. - To our knowledge, we conducted the first analysis on duration of adjuvant chemotherapy in this setting. - Adjuvant chemotherapy cycles 0.002 <. - We expect more studies in the future to provide high-level evidence of the optimal duration of adjuvant chemotherapy in GC.. - 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