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.
BMC Cancer. 2021 Jul 9;21(1):796. doi: 10.1186/s12885-021-08487-z.
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.
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.
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.
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.
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。
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。
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。
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。
