J Gastric Cancer.  2018 Mar;18(1):58-68. 10.5230/jgc.2018.18.e5.

Effect of Early Adjuvant Chemotherapy on Survival of Advanced Gastric Cancer Patients: a Propensity Score-matched Analysis

• Lee Y
• Min SH
• Park KB
• Park YS
• Kim JW
• Ahn SH
• Kim JW
• Park DJ
• Lee KW
• Kim HH

• KMID: 2414547
• DOI: http://doi.org/10.5230/jgc.2018.18.e5

Abstract

PURPOSE
Generally, adjuvant chemotherapy (AC) should be initiated as soon as possible after surgery to eradicate microscopic cancer cells. In this study, we investigated the effect of early AC on the survival of stage II/III gastric cancer patients.
MATERIALS AND METHODS
Four hundred sixty patients who received AC (S-1 or XELOX) for pathologic stage II/III gastric cancer at Seoul National University Bundang Hospital between January 2008 and December 2014 were included. Patients were divided into 2 groups: early AC administration (within 4 weeks) and late AC administration (more than 4 weeks). Patients in the early AC group (n=174) were matched 1:1 with patients in the late AC group (n=174) by propensity scoring to adjust for clinical differences. Three-year relapse-free survival (RFS) was evaluated according to the timing of AC.
RESULTS
Three-year RFS was 98.1% in stage IIA (n=109), 85.0% in stage IIB (n=83), 87.4% in stage IIIA (n=96), 83.5% in stage IIIB (n=91), and 62.5% in stage IIIC (n=81). After propensity score matching, RFS was similar between early and late AC groups (hazard ratio [HR],1.04; 95% confidence interval [CI], 0.62-1.74; P=0.889). Pathologic stage and histological type were independent prognostic factors of RFS (HR, 2.05; 95% CI, 1.06-3.96; P=0.033 and HR, 2.61; 95% CI, 1.42-4.80; P=0.002, respectively).
CONCLUSIONS
Early initiation of AC within 4 weeks does not affect survival rates in stage II/III gastric cancer.

Keyword

Stomach neoplasms; Chemotherapy; Adjuvant drug therapy; Survival rate; Propensity score

MeSH Terms

Chemotherapy, Adjuvant*
Drug Therapy
Humans
Propensity Score
Seoul
Stomach Neoplasms*
Survival Rate

Figure

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  Fig. 1 The distribution of time to initiation of AC. The median interval between surgery and AC was 5 weeks (range, 2–9 weeks).AC = adjuvant chemotherapy.

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  Fig. 2 RFS according to pathologic stage. The 3-year RFS was 98.1% in stage IIA (n=109), 85.0% in stage IIB (n=83), 87.4% in stage IIIA (n=96), 83.5% in stage IIIB (n=91), and 62.5% in stage IIIC (n=81).RFS = relapse-free survival.

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