Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
Department of Gastroenterological Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
Eur Surg Res. 2021;62(1):40-52. doi: 10.1159/000515175. Epub 2021 Apr 1.
The predictive factors for discontinuation of S-1 administration and prognostic factors in elderly patients with pStage II/III gastric cancer receiving S-1 adjuvant chemotherapy remain unclear.
Between January 2004 and December 2016, 80 elderly gastric cancer patients (≥70 years) undergoing curative D2 gastrectomy were enrolled in this study. Predictive factors for completion of S-1 administration over 1 year, adverse events due to S-1 administration, and prognostic factors for overall survival (OS) and relapse-free survival (RFS) were evaluated.
Twenty-eight patients (35%) completed 8 courses of S-1. The median relative dose intensity was 82.1% (IQR 31.1-100%). The incidence rates of hematological and nonhematological adverse events were acceptable. Distal gastrectomy was an independent predictive factor for completion of S-1 administration (odds ratio [OR] 0.364; 95% confidence interval [CI] 0.141-0.939; p = 0.037). Higher postoperative neutrophil count/lymphocyte count (N/L) ratio and more advanced stage adversely influenced OS. Multivariate analysis revealed that a higher postoperative N/L ratio and more advanced stage adversely affected RFS.
To complete adjuvant S-1 administration to elderly patients with pStage II/III gastric cancer, total gastrectomy should be avoided if possible. A new regimen for elderly gastric cancer patients with higher postoperative N/L ratios and more advanced stage should be established.
接受 S-1 辅助化疗的 pStage II/III 期老年胃癌患者停止 S-1 治疗的预测因素和预后因素仍不清楚。
2004 年 1 月至 2016 年 12 月，本研究纳入 80 例接受根治性 D2 胃切除术的老年胃癌患者（≥70 岁）。评估了完成 S-1 治疗 1 年以上、S-1 治疗相关不良事件、总生存（OS）和无复发生存（RFS）的预测因素。
28 例（35%）患者完成 8 个疗程的 S-1 治疗。中位相对剂量强度为 82.1%（IQR 31.1-100%）。血液学和非血液学不良事件的发生率可以接受。远端胃切除术是完成 S-1 治疗的独立预测因素（优势比 [OR] 0.364；95%置信区间 [CI] 0.141-0.939；p=0.037）。术后中性粒细胞/淋巴细胞计数（N/L）比值较高和更晚期的肿瘤分期不良影响 OS。多因素分析显示，术后 N/L 比值较高和更晚期肿瘤分期不良影响 RFS。
为了让接受 pStage II/III 期胃癌的老年患者完成辅助 S-1 治疗，如果可能的话应避免全胃切除术。对于术后 N/L 比值较高和更晚期的老年胃癌患者，应建立新的治疗方案。
