Miyatani Kozo, Takahashi Tomohiro, Shimizu Shota, Shishido Yuji, Hanaki Takehiko, Kihara Kyoichi, Matsunaga Tomoyuki, Yamamoto Manabu, Tokuyasu Naruo, Takano Shuichi, Sakamoto Teruhisa, Hasegawa Toshimichi, Saito Hiroaki, Fujiwara Yoshiyuki
Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan.
Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, 680‑8517, Japan.
Surg Today. 2025 Apr 16. doi: 10.1007/s00595-025-03038-6.
This study aimed to clarify the significance of the relative dose intensity (RDI) of S-1 adjuvant chemotherapy (ACT) after gastrectomy in elderly patients with stage II/III gastric cancer (GC) and to determine whether the cachexia index (CXI) correlates with RDI.
We enrolled 76 patients with stage II/III GC, aged > 70 years. The overall survival (OS) and disease-specific survival (DSS) of participants in the surgery alone, S-1 ACT completion (RDI ≥ 58%), and S-1 ACT non-completion (RDI < 58%) groups were compared. In addition, the clinicopathological determinants of RDI were examined.
The S-1 ACT completion group had better OS and DSS, while the prognoses of patients in the surgery alone and S-1 ACT non-completion groups did not differ significantly. S-1 ACT non-completion or surgery alone was identified as an independent poor prognostic factor for OS and DSS. Furthermore, a multivariate analysis revealed that a high preoperative CXI (≥ 75.5 for males and ≥ 79.4 for females) was an independent predictor of success in achieving an RDI ≥ 58%.
A higher preoperative CXI can result in a higher RDI and improve the prognosis of elderly patients with stage II/III GC who underwent S-1 ACT.
本研究旨在阐明老年II/III期胃癌（GC）患者胃切除术后S-1辅助化疗（ACT）的相对剂量强度（RDI）的意义，并确定恶病质指数（CXI）是否与RDI相关。
我们纳入了76例年龄大于70岁的II/III期GC患者。比较了单纯手术组、S-1 ACT完成组（RDI≥58%）和S-1 ACT未完成组（RDI<58%）参与者的总生存期（OS）和疾病特异性生存期（DSS）。此外，还检查了RDI的临床病理决定因素。
S-1 ACT完成组的OS和DSS更好，而单纯手术组和S-1 ACT未完成组患者的预后无显著差异。S-1 ACT未完成或单纯手术被确定为OS和DSS的独立不良预后因素。此外，多因素分析显示，术前高CXI（男性≥75.5，女性≥79.4）是实现RDI≥58%成功的独立预测因素。
术前较高的CXI可导致较高的RDI，并改善接受S-1 ACT的老年II/III期GC患者的预后。
