可切除胃癌的单纯手术、辅助替加氟/吉美嘧啶/奥替拉西（S-1）或铂类化疗：真实世界经验和倾向评分匹配分析。
Surgery alone, adjuvant tegafur/gimeracil/octeracil (S-1), or platinum-based chemotherapies for resectable gastric cancer: real-world experience and a propensity score matching analysis.
机构信息
Division of Hematology/ Oncology, Department of Internal Medicine, National Cheng Kung University Hospital Douliou Branch, Yunlin, Taiwan.
Institute of Clinical Medicine, School of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
BMC Cancer. 2021 Jul 9;21(1):796. doi: 10.1186/s12885-021-08487-z.
BACKGROUND
Adjuvant chemotherapy has changed the paradigm in resectable gastric cancer. S-1 is an oral chemotherapeutic with promising efficacy in Asia. However, comparisons with close observation or platinum-based doublets post D2 gastrectomy have been less reported, notably on real-world experiences.
METHODS
We retrospectively evaluated patients with D2-dissected stage IB-III gastric cancer who received S-1 (S-1, n = 67), platinum-based doublets (P, n = 145) and surgery with close observation (OBS, n = 221) from Jan 2008 to Oct 2018. A propensity score matching was used to compare for recurrence-free (RFS) and overall survivals (OS) in patients who had a locally-advanced disease (T3-4 or lymph node-positive). Adverse reactions, dosage, and associated factors for S-1 are also discussed.
RESULTS
In a median follow-up time of 51.9 months, adjuvant S-1 monotherapy was associated with an intermediate survival as compared with P and OBS (median RFS/OS: S-1 vs. P, 20.9/35.8 vs. 31.2/50.5 months, HR = 1.76/2.14, p = 0.021/0.008; S-1 vs. OBS, 24.4/40.2 vs. 20.7/27.0 months, HR = 0.62/0.55, p = 0.041/0.024). The survival differences were more prominent in patients with N2-3 diseases. S-1 was well-tolerated with a relative dose intensity of 73.6%, a median duration of 8.3 months and associated with less adverse reactions as compared with P. S-1 monotherapy was selected by physicians based on age, lymph node stage, serum carcinoembryonic antigen and disease stage.
CONCLUSIONS
Adjuvant S-1 correlated with intermediate survival outcomes between OBS and P but conferred fewer adverse reactions as compared with P. Patients with a moderate risk of recurrence had comparable survivals when treated with S-1 while platinum-based doublets were favored in advanced cases. The study provides additional information about adjuvant S-1 in patients with selected risk of recurrence.
背景
辅助化疗改变了可切除胃癌的治疗模式。替吉奥（S-1）是一种口服化疗药物，在亚洲具有良好的疗效。然而，与 D2 胃切除术后密切观察或铂类双联化疗相比，其相关报道较少，尤其是在真实世界的经验中。
方法
我们回顾性评估了 2008 年 1 月至 2018 年 10 月期间接受 S-1（S-1 组，n=67）、铂类双联化疗（P 组，n=145）和手术密切观察（OBS 组，n=221）治疗的 D2 解剖分期 IB-III 期胃癌患者。采用倾向评分匹配比较局部进展期（T3-4 或淋巴结阳性）患者的无复发生存（RFS）和总生存（OS）。还讨论了 S-1 的不良反应、剂量和相关因素。
结果
中位随访时间为 51.9 个月，与 P 和 OBS 相比，S-1 单药辅助治疗的生存时间居中（中位 RFS/OS：S-1 与 P 相比，20.9/35.8 与 31.2/50.5 个月，HR=1.76/2.14，p=0.021/0.008；S-1 与 OBS 相比，24.4/40.2 与 20.7/27.0 个月，HR=0.62/0.55，p=0.041/0.024）。在 N2-3 疾病患者中，生存差异更为显著。与 P 相比，S-1 具有良好的耐受性，相对剂量强度为 73.6%，中位持续时间为 8.3 个月，不良反应较少。S-1 单药治疗是根据患者年龄、淋巴结分期、血清癌胚抗原和疾病分期由医生选择的。
结论
与 OBS 和 P 相比，S-1 辅助治疗与中等生存结果相关，但与 P 相比不良反应较少。复发风险中等的患者接受 S-1 治疗时具有可比的生存结果，而铂类双联化疗则适用于晚期病例。该研究为特定复发风险患者的 S-1 辅助治疗提供了更多信息。
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