Wang Fei-Yu, Huang Xiang-Ming, Cao Yu-Qing, Cao Jie, Song Meng, Fang Zhi-Jun, Huang Xin-En
Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
World J Surg Oncol. 2025 Mar 7;23(1):75. doi: 10.1186/s12957-025-03723-3.
Adjuvant chemotherapy is the conventional treatment for stage II and III gastric cancer(GC). Postoperative doublet chemotherapy has consistently shown improved survival outcomes in advanced-stage GC patients compared to single-agent regimens. Triplet regimens have shown significant survival benefits in the perioperative settings. This retrospective study evaluated the efficacy and safety of paclitaxel/S-1/oxaliplatin (PSOX) compared to S-1/oxaliplatin (SOX) as postoperative adjuvant chemotherapy in stage II-III GC patients following D2 gastrectomy.
A retrospective review was conducted on patients with histologically confirmed stage II-III gastric cancer who underwent D2 gastrectomy at Jiangsu Cancer Hospital, categorizing them into two groups. A total of 75 patients were included in PSOX group and 81 patients in the SOX group between April 2018 and August 2021. Patients in PSOX group received paclitaxel (120 mg/m), oxaliplatin (100 mg/m) and S-1 (80 - 60 mg/d) per cycle, while those patients in SOX group were administrated oxaliplatin (130 mg/m) and S-1 (80-120 mg/d) per cycle. Patients from both groups were matched in a 1:1 ratio using propensity scores to assess differences in disease-free survival (DFS) and safety.
The 3-year DFS rate was 78.2% for the PSOX group and 74.0% for the SOX group (P = 0.355), with a hazard ratio for peritoneal relapse of 0.287 (95% CI, 0.090-0.915; P = 0.035). Subgroup analysis indicated that stage IIIC GC patients in the PSOX group had a higher DFS rate than those in the SOX group(P = 0.032). Grade 3 or 4 adverse events, as per the National Cancer Institute Common Toxicity Criteria, such as leucopenia (10.6% vs. 4.5%), neutropenia (10.6% vs. 9.1%), nausea/vomiting (4.5% vs. 3.0%), and diarrhea (4.5% vs. 3.0%) were relatively common in the PSOX group compared to the SOX group, with no statistically significant differences between the two groups.
Our findings suggested that adjuvant PSOX chemotherapy offers superior survival benefits compared to the SOX regimen in patients with staged IIIC GC after D2 gastrectomy. The incidence of adverse events with PSOX chemotherapy was comparable to that of SOX chemotherapy.
辅助化疗是II期和III期胃癌（GC）的常规治疗方法。与单药方案相比，术后双联化疗在晚期GC患者中一直显示出更好的生存结果。三联方案在围手术期已显示出显著的生存获益。本回顾性研究评估了紫杉醇/S-1/奥沙利铂（PSOX）与S-1/奥沙利铂（SOX）相比，作为II-III期GC患者D2胃切除术后辅助化疗的疗效和安全性。
对在江苏省肿瘤医院接受D2胃切除术且组织学确诊为II-III期胃癌的患者进行回顾性分析，将其分为两组。2018年4月至2021年8月期间，PSOX组共纳入75例患者，SOX组纳入81例患者。PSOX组患者每周期接受紫杉醇（120mg/m²）、奥沙利铂（100mg/m²）和S-1（80 - 60mg/d）治疗，而SOX组患者每周期接受奥沙利铂（130mg/m²）和S-1（80 - 120mg/d）治疗。使用倾向评分将两组患者按1:1比例匹配，以评估无病生存期（DFS）和安全性的差异。
PSOX组3年DFS率为78.2%，SOX组为74.0%（P = 0.355），腹膜复发的风险比为0.287（95%CI，0.090 - 0.915；P = 0.035）。亚组分析表明，PSOX组的IIIC期GC患者DFS率高于SOX组（P = 0.032）。根据美国国立癌症研究所常见毒性标准，3级或4级不良事件，如白细胞减少（10.6%对4.5%）、中性粒细胞减少（10.6%对9.1%）、恶心/呕吐（4.5%对3.0%）和腹泻（4.5%对3.0%）在PSOX组中比SOX组相对更常见，但两组之间无统计学显著差异。
我们的研究结果表明，对于D2胃切除术后的IIIC期GC患者，辅助PSOX化疗比SOX方案具有更好的生存获益。PSOX化疗的不良事件发生率与SOX化疗相当。
