Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer.

BACKGROUND AND OBJECTIVES

We analyzed in a retrospective analysis whether adjuvant chemotherapy with mitomycin (MMC) alone or with Tegafur (TG) is associated with long-term survival benefit in resected gastric cancer. Other prognostic factors are compared.

METHODS

From 1977 to 1998, 314 consecutive totally resected gastric adenocarcinoma patients have been included in a survival study. In 151 patients no adjuvant therapy was given. In 163 patients, four courses of adjuvant chemotherapy was given, 109 of them with MMC, 10-20 mg/m(2) i.v. every 6 weeks and the other 54 with MMC plus TG, 500 mg/m(2) p.o. day for 42 consecutive days. Univariate and multivariate survival analyses were performed.

RESULTS

Survival benefit was seen in patients who had received adjuvant chemotherapy compared with the controls (52% vs. 30% alive at the end of the study, relative risk = 0.46, 95% CI: 0.33-0.62, P < 0.0001), women (52% vs. 35%, RR = 0.83, 95% CI: 0.71-0.98, P = 0.0342) and increment of staging IB, II, IIIA, or IIIB (80, 56, 24 vs. 13%, respectively, RR = 1.83, 95% CI: 1.42-2.35, P < 0.0001). Better prognosis of node-negative patients was observed only in univariate analysis.

CONCLUSIONS

After curative surgery, adjuvant chemotherapy with mitomycin C, both alone or combined with Tegafur, improved the long-term cure rate over no postoperative chemotherapy in locally advanced gastric cancer patients. This benefit was not influenced by other prognostic factors.