Wang Jin, Li Zhi, Qu Jinglei, Song Na, Chen Ying, Cheng Yu, Zhang Simeng, Qu Xiujuan, Liu Yunpeng
Department of Medical Oncology, Ministry of Education, the First Hospital of China Medical University, Shenyang, China.
Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, Ministry of Education, the First Hospital of China Medical University, Shenyang, China.
J Gastrointest Oncol. 2020 Aug;11(4):674-684. doi: 10.21037/jgo-20-52.
Fluoropyrimidine-based regimens are the cornerstone of first-line chemotherapy for metastatic gastric cancer (GC). Capecitabine or S-1 might be used as an alternative to infusional 5-fluorouracil, especially in pan-Asian. This study aimed to compare the clinical outcomes of capecitabine-based and S-1-based regimens as first-line chemotherapy in Chinese patients with unresectable or metastatic GC.
We conducted a retrospective study including unresectable or metastatic GC patients treated with the capecitabine-based or S-1-based regimen as first-line chemotherapy at the First Hospital of China Medical University. Propensity score matching (PSM) analysis was performed to reduce selection bias. Overall survival (OS) outcomes were compared using the Kaplan-Meier method and log-rank test. Prognostic significance was determined using multivariate Cox regression analysis. In addition, subgroup analyses were conducted to determine the effectiveness of capecitabine-based and S-1-based regimens in clinically relevant patient subsets.
The clinical data of 469 patients included between October 2005 and September 2018. PSM analysis identified 187 patients receiving capecitabine-based or S-1-based regimen. No significant difference in OS (10.7 11.1 months, P=0.523) was detected between the two groups after PSM. In the subgroup analysis, the median OS (12.2 9.3 months, P=0.013) was longer for patients with peritoneum metastasis who received the capecitabine-based regimen compared to those who received the S-1-based regimen.
No significant difference in clinical outcomes was observed between the capecitabine and S-1-based regimen as first-line chemotherapy for metastatic or unresectable GC patients in China. The capecitabine-based regimen should be considered in the treatment of the GC patients with peritoneum metastasis.
基于氟嘧啶的方案是转移性胃癌（GC）一线化疗的基石。卡培他滨或S-1可作为静脉输注5-氟尿嘧啶的替代药物，尤其是在泛亚洲地区。本研究旨在比较在中国不可切除或转移性GC患者中，以卡培他滨为基础的方案和以S-1为基础的方案作为一线化疗的临床结局。
我们进行了一项回顾性研究，纳入在中国医科大学附属第一医院接受以卡培他滨为基础或S-1为基础方案一线化疗的不可切除或转移性GC患者。进行倾向评分匹配（PSM）分析以减少选择偏倚。采用Kaplan-Meier法和对数秩检验比较总生存（OS）结局。使用多因素Cox回归分析确定预后意义。此外，进行亚组分析以确定以卡培他滨为基础和以S-1为基础的方案在临床相关患者亚组中的有效性。
纳入了2005年10月至2018年9月期间469例患者的临床数据。PSM分析确定了187例接受以卡培他滨为基础或S-1为基础方案的患者。PSM后两组间OS无显著差异（10.7对11.1个月，P=0.523）。在亚组分析中，与接受S-1为基础方案的患者相比，接受以卡培他滨为基础方案的腹膜转移患者的中位OS更长（12.2对9.3个月，P=0.013）。
在中国，对于转移性或不可切除的GC患者，以卡培他滨为基础的方案和以S-1为基础的方案作为一线化疗的临床结局无显著差异。对于有腹膜转移的GC患者，应考虑采用以卡培他滨为基础的方案进行治疗。
