Brief Article
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World J Gastroenterol. Jun 7, 2013; 19(21): 3309-3315
Published online Jun 7, 2013. doi: 10.3748/wjg.v19.i21.3309
Efficacy of adjuvant XELOX and FOLFOX6 chemotherapy after D2 dissection for gastric cancer
Ying Wu, Zhe-Wei Wei, Yu-Long He, Roderich E Schwarz, David D Smith, Guang-Kai Xia, Chang-Hua Zhang
Ying Wu, Zhe-Wei Wei, Yu-Long He, Guang-Kai Xia, Chang-Hua Zhang, Department of Gastrointestinopancreatic Surgery of the First Affiliated Hospital of Sun Yat-Sen University, Gastric Cancer Center of Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
Roderich E Schwarz, IU Health Goshen Center for Cancer Care, Indiana University, Goshen, IN 46526, United States
David D Smith, Division of Biostatistics, City of Hope National Medical Center, Duarte, CA 91010, United States
Author contributions: Wu Y and Wei ZW contributed equally to this work; He YL, Schwarz RE and Zhang CH designed the research; Wu Y, Wei ZW, Xia GK and Zhang CH performed the research; Wu Y, Wei ZW and Smith DD analyzed the data; Wu Y, Wei ZW and Zhang CH wrote the paper.
Supported by National Natural Science Foundation of China, No. 30700805 and 81272643; Project 5010 from Sun Yat-Sen University, No. 20100816; Young Teacher Training Project of Sun Yat-Sen University, No. 09ykpy49
Correspondence to: Chang-Hua Zhang, MD, PhD, Department of Gastrointestinopancreatic Surgery of the First Affiliated Hospital of Sun Yat-Sen University, Gastric Cancer Center of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, Guangdong Province, China. zhchangh@mail.sysu.edu.cn
Telephone: +86-20-87331059 Fax: +86-20-87331059
Received: January 30, 2013
Revised: April 16, 2013
Accepted: May 7, 2013
Published online: June 7, 2013
Processing time: 125 Days and 9.4 Hours
Abstract

AIM: To compare the efficacy of capecitabine and oxaliplatin (XELOX) with 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX6) in gastric cancer patients after D2 dissection.

METHODS: Between May 2004 and June 2010, patients in our gastric cancer database who underwent D2 dissection for gastric cancer at the First Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed. A total of 896 patients were enrolled into this study according to the established inclusion and exclusion criteria. Of these patients, 214 received the XELOX regimen, 48 received FOLFOX6 therapy and 634 patients underwent surgery only without chemotherapy. Overall survival was compared among the three groups using Cox regression and propensity score matched-pair analyses.

RESULTS: Patients in the XELOX and FOLFOX6 groups were younger at the time of treatment (median age 55.2 years; 51.2 years vs 58.9 years), had more undifferentiated tumors (70.1%; 70.8% vs 61.4%), and more lymph node metastases (80.8%; 83.3% vs 57.7%), respectively. Overall 5-year survival was 57.3% in the XELOX group which was higher than that (47.5%) in the surgery only group (P = 0.062) and that (34.5%) in the FOLFOX6 group (P = 0.022). Multivariate analysis showed that XELOX therapy was an independent prognostic factor (hazard ratio = 0.564, P < 0.001). After propensity score adjustment, XELOX significantly increased overall 5-year survival compared to surgery only (58.2% vs 44.2%, P = 0.025) but not compared to FOLFOX6 therapy (48.5% vs 42.7%, P = 0.685). The incidence of grade 3/4 adverse reactions was similar between the XELOX and FOLFOX6 groups, and more patients suffered from hand-foot syndrome in the XELOX group (P = 0.018).

CONCLUSION: Adjuvant XELOX therapy is associated with better survival in patients after D2 dissection, but does not result in a greater survival benefit compared with FOLFOX6 therapy.

Keywords: Gastric cancer; D2 dissection; Adjuvant; Capecitabine and oxaliplatin; 5-fluorouracil, folinic acid and oxaliplatin

Core tip: This original study retrospectively analyzed the efficacy of adjuvant chemotherapy and compared the effects of adjuvant capecitabine and oxaliplatin (XELOX) therapy with 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX6) therapy in gastric cancer patients undergoing D2 dissection. Propensity score matched-pair analysis was performed to account for biases associated with retrospective data. Adjuvant XELOX was significantly associated with improved survival after D2 dissection compared to surgery alone following multivariate Cox regression and propensity score matched analyses, however, the XELOX regimen did not result in a greater survival benefit compared with the FOLFOX6 regimen. Our findings suggest that adjuvant XELOX therapy should be considered in curable gastric cancer patients.