J Gastric Cancer.  2020 Jun;20(2):152-164. 10.5230/jgc.2020.20.e13.

Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study

Affiliations
  • 1Department of Surgery, Korea University College of Medicine, Seoul, Korea
  • 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
  • 4Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
  • 5Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
  • 7Department of Surgery, Ajou University School of Medicine, Suwon, Korea
  • 8Department of Surgery, Dankook University Hospital, Cheonan, Korea
  • 9Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 10Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
  • 11Department of Surgery, Konyang University Hospital, Daejeon, Korea
  • 12Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
  • 13Department of Surgery, Kosin University College of Medicine, Busan, Korea
  • 14Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
  • 15Department of Surgery, Jeju National University Hospital, Jeju, Korea
  • 16Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 17Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  • 18Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
  • 19Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea
  • 20Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
  • 21Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 22Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
  • 23Department of Surgery, Eulji University Hospital, Daejeon, Korea
  • 24Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea

Abstract

Purpose
To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC).
Materials and Methods
This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively.
Results
The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693–4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664–1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595–85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502–5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618–3.028; P<0.001) were determined as independent prognostic factors for DFS.
Conclusions
S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.

Keyword

Gastric cancer; Adjuvant chemotherapy; Disease-free survival
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