辅助化疗 S-1 起始时间或持续时间；哪项真正影响 II 期和 III 期胃癌的生存？
Time to initiation or duration of S-1 adjuvant chemotherapy; which really impacts on survival in stage II and III gastric cancer?
机构信息
Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Japan.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
出版信息
Gastric Cancer. 2018 May;21(3):446-452. doi: 10.1007/s10120-017-0767-9. Epub 2017 Sep 30.
BACKGROUND
Surgical resection with S-1 adjuvant chemotherapy (AC) is the standard of care for stage II-III gastric cancer (GC). However, it is unclear if time to initiation and duration of S-1 AC impact on survival.
METHODS
A multi-institutional GC database identified 498 patients who were treated with S-1 AC after D2 or more extended radical surgery for stage II-III gastric cancer. Patients were divided into four groups according to the interval between surgery and initiation of AC and the duration of AC as follows: group A (n = 226), who received AC earlier (≤6 weeks) and for longer (≥6 months) after surgery; group B (n = 160), who received AC later (>6 weeks) and for longer after surgery; group C (n = 46), who received AC earlier but for a shorter period (<6 months) after surgery; and group D (n = 66), who received AC later and for a shorter period after surgery. Prognostic factors for overall survival (OS) were investigated using multivariate analysis.
RESULTS
The 5-year OS was 69.5%. Pathological stage II disease (hazard ratio (HR), 0.334; 95% confidence interval (CI), 0.215-0.499), with an OS of 85.8% versus 60.5% for stage III disease, as well as a longer duration (≥6 months) of S-1 (HR, 0.498; 95% CI, 0.355-0.706), with an OS of 74.3% versus 53.0% for a shorter duration (<6 months) of S-1, were identified as significant prognostic factors for long-term survival. Time to initiation was not associated with OS.
CONCLUSIONS
A duration of S-1 AC of ≥6 months, but not time to initiation within 6 weeks, impacts on OS in stage II-III gastric cancer.
背景
对于 II-III 期胃癌（GC），手术切除联合 S-1 辅助化疗（AC）是标准治疗方法。然而，S-1 AC 的起始时间和持续时间是否影响生存尚不清楚。
方法
一个多机构的 GC 数据库纳入了 498 例接受 D2 或更广泛的根治性手术后，接受 S-1 AC 治疗的 II-III 期胃癌患者。根据手术后开始 AC 的时间间隔和 AC 的持续时间，将患者分为四组：A 组（n=226），接受更早（≤6 周）和更长（≥6 个月）的 AC；B 组（n=160），接受更晚（>6 周）和更长的 AC；C 组（n=46），接受更早但更短（<6 个月）的 AC；D 组（n=66），接受更晚和更短的 AC。使用多变量分析研究总生存（OS）的预后因素。
结果
5 年 OS 为 69.5%。病理分期 II 期疾病（风险比（HR），0.334；95%置信区间（CI），0.215-0.499），OS 为 85.8%，而 III 期疾病为 60.5%，以及 S-1 更长的持续时间（≥6 个月）（HR，0.498；95%CI，0.355-0.706），OS 为 74.3%，而 S-1 较短的持续时间（<6 个月）为 53.0%，被确定为长期生存的显著预后因素。起始时间与 OS 无关。
结论
S-1 AC 的持续时间≥6 个月，但 6 周内开始时间不影响 II-III 期胃癌的 OS。
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