Terayama Masayoshi, Ohashi Manabu, Yamaguchi Kensei, Takahari Daisuke, Makuuchi Rie, Hayami Masaru, Ida Satoshi, Kumagai Koshi, Sano Takeshi, Nunobe Souya
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital Japanese Foundation for Cancer Research Tokyo Japan.
Department of Gastroenterological Chemotherapy, Gastroenterological Center Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Ann Gastroenterol Surg. 2024 Jul 3;9(1):60-68. doi: 10.1002/ags3.12840. eCollection 2025 Jan.
The standard adjuvant chemotherapy regimen for stage III gastric cancer is docetaxel plus S-1 (DS) based on the results of the START-II trials. However, in clinical practice some patients could not continue this intensive doublet chemotherapy because of limited tolerability. This study aimed to assess the practical feasibility of DS and elucidate the predictive factors for the completion of adjuvant DS therapy.
Data from consecutive patients who underwent radical gastrectomy between 2018 and 2021 and were diagnosed with histopathologically confirmed stage III gastric cancer were retrospectively collected. First, the completion rate and adverse effects of DS were assessed. Second, the association between DS incompletion and patient backgrounds including body weight, skeletal muscle index (SMI), and intramuscular adipose content (IMAC) were examined.
Of 87 patients, 59 patients (67.8%) completed DS and dose reduction was required in 18 patients (20.6%). Neutropenia of grade 3 or higher was the most common hematological toxicity observed (17.2%). The most frequent nonhematological toxicity of grade 3 or higher was fatigue (6.9%), followed by diarrhea (5.7%), nausea (4.5%), and anorexia (4.5%). In a multivariate analysis, low SMI ( = 0.005) and high IMAC ( = 0.004) were significant risk factors for DS incompletion.
DS adjuvant chemotherapy after radical gastrectomy for pathological stage III gastric cancer is acceptable, even in clinical practice, with respect to completion and toxicity. Additionally, the body composition factors such as SMI and IMAC might be useful in predicting incompletion of DS. These findings will help us to preoperatively select patients for DS.
基于START-II试验的结果，多西他赛联合S-1（DS）是III期胃癌的标准辅助化疗方案。然而，在临床实践中，一些患者由于耐受性有限而无法继续这种强化的双联化疗。本研究旨在评估DS方案的实际可行性，并阐明辅助性DS治疗完成情况的预测因素。
回顾性收集2018年至2021年间接受根治性胃切除术且经组织病理学确诊为III期胃癌的连续患者的数据。首先，评估DS方案的完成率和不良反应。其次，研究DS方案未完成与患者背景（包括体重、骨骼肌指数（SMI）和肌内脂肪含量（IMAC））之间的关联。
87例患者中，59例（67.8%）完成了DS方案，18例（20.6%）需要减量。观察到的最常见的3级或更高等级的血液学毒性是中性粒细胞减少（17.2%）。最常见的3级或更高等级的非血液学毒性是疲劳（6.9%），其次是腹泻（5.7%）、恶心（4.5%）和厌食（4.5%）。在多变量分析中，低SMI（P = 0.005）和高IMAC（P = 0.004）是DS方案未完成的显著危险因素。
对于病理分期为III期的胃癌患者，根治性胃切除术后的DS辅助化疗在完成率和毒性方面是可以接受的，即使在临床实践中也是如此。此外，SMI和IMAC等身体成分因素可能有助于预测DS方案的未完成情况。这些发现将有助于我们在术前选择适合DS方案的患者。
