Ishida Hiroo, Sunakawa Yu, Kodera Yasuhiro, Yoshida Kazuhiro, Kochi Mitsugu, Kakeji Yoshihiro, Sano Takeshi, Takeuchi Masahiro, Ichikawa Wataru, Fujii Masashi
Division of Medical Oncology, Showa University Fujigaoka Hospital, Japan.
Department of Clinical Oncology, St. Marianna University School of Medicine, Japan.
Eur J Cancer. 2025 Mar 26;219:115322. doi: 10.1016/j.ejca.2025.115322. Epub 2025 Feb 20.
As adjuvant chemotherapy for stage III gastric cancer, the phase III (JACCRO GC-07) trial showed that docetaxel plus S-1 (DS) was superior to S-1 in terms of recurrence-free and overall survival. However, whether adding docetaxel to S-1 in the adjuvant setting affects survival after recurrence remains unclear. The optimal treatment strategy for patients who develop recurrence during or after DS has also been controversial.
We used results from JACCRO GC-07 to investigate post-recurrence survival (PRS) in patients who developed recurrence during or after completing adjuvant chemotherapy. PRS was compared between adjuvant groups and among post-recurrence chemotherapeutic regimens.
During 5 years of follow-up after surgery, 161 of 441 patients in the DS group and 216 of 452 patients in the S-1 group developed recurrence, with median PRS of 12.6 and 11.4 months, respectively (hazard ratio [HR] 0.98, 95 % confidence interval [CI] 0.79-1.22; p = 0.84). Among patients with recurrence, 115 patients in the DS group and 165 patients in the S-1 group received chemotherapy, and median PRS was 14.5 and 13.7 months, respectively (HR 1.04, 95 %CI 0.81-1.34; p = 0.76). Platinum-based chemotherapy resulted in longer PRS than non-platinum chemotherapy, regardless of the adjuvant chemotherapeutic regimen or time of recurrence.
PRS was similar between patients who received adjuvant chemotherapy with DS or with S-1 alone. PRS was also similar between groups of patients who received chemotherapy after recurrence. Platinum-based chemotherapy might be the optimal treatment for patients who develop recurrence after completing adjuvant DS, regardless of the time of recurrence.
作为Ⅲ期胃癌的辅助化疗，Ⅲ期（JACCRO GC - 07）试验表明，多西他赛联合S - 1（DS）在无复发生存期和总生存期方面优于S - 1。然而，在辅助治疗中，S - 1加用多西他赛是否会影响复发后的生存情况仍不清楚。对于在DS治疗期间或之后出现复发的患者，最佳治疗策略也一直存在争议。
我们利用JACCRO GC - 07的结果，调查在辅助化疗期间或完成辅助化疗后出现复发的患者的复发后生存期（PRS）。比较辅助治疗组之间以及复发后化疗方案之间的PRS。
术后5年随访期间，DS组441例患者中有161例复发，S - 1组452例患者中有216例复发，PRS中位数分别为12.6个月和11.4个月（风险比[HR] 0.98，95%置信区间[CI] 0.79 - 1.22；p = 0.84）。在复发患者中，DS组115例患者和S - 1组165例患者接受了化疗，PRS中位数分别为14.5个月和13.7个月（HR 1.04，95%CI 0.81 - 1.34；p = 0.76）。无论辅助化疗方案或复发时间如何，铂类化疗的PRS均长于非铂类化疗。
接受DS辅助化疗或单独接受S - 1辅助化疗的患者的PRS相似。复发后接受化疗的患者组之间的PRS也相似。对于完成辅助DS治疗后出现复发的患者，无论复发时间如何，铂类化疗可能是最佳治疗方法。
