Published online Sep 26, 2018. doi: 10.12998/wjcc.v6.i10.373
Peer-review started: June 8, 2018
First decision: July 3, 2018
Revised: July 17, 2018
Accepted: August 27, 2018
Article in press: August 28, 2018
Published online: September 26, 2018
Processing time: 110 Days and 18.8 Hours
To investigate the safety and efficacy of S-1 plus oxaliplatin (SOX) as an adjuvant chemotherapy regimen in gastric cancer (GC) after D2 dissection.
GC Patients who underwent D2 gastrectomy from September 2009 to December 2011 in four Chinese institutions were enrolled. Patients with stage IB-IIIC GC, who received adjuvant SOX treatment were matched by propensity scores with those who underwent surgery alone and those who conducted capecitabine plus oxaliplatin (XELOX) regimen. Disease-free survival (DFS) and overall survival (OS) were compared among the groups. In addition, adverse events in SOX patients were analyzed.
Of 1944 GC patients who underwent D2 dissection, 867 were included for analysis. One hundred and seventeen patients treated with SOX were matched to 234 patients who conducted surgery alone. Fifty-seven patients treated with SOX were matched to 57 patients who received XELOX. The estimated five-year DFS was 57.5% in the adjuvant SOX group which was higher than that (44.6%) in the surgery alone group (P = 0.001); and the estimated five-year OS was 68.3% which was higher than that (45.8%) of surgery alone group (P < 0.001). Survival benefit was also revealed in stage III and > 60 years old subgroups (P < 0.001 and P = 0.015, respectively). Compared with XELOX regimen, SOX showed no significant difference in DFS (P = 0.340) and OS (P = 0.361). The most common ≥ 3 grade adverse events of SOX regimen were neutropenia (22.6%), leukopenia (8.9%) and thrombocytopenia (5.6%).
Compared with surgery alone, SOX regimen significantly improves the long-term survival and has acceptable toxicity in patients with stage IB-IIIC GC after D2 dissection. It may be a novel adjuvant chemotherapy regimen in GC patients.
Core tip: Based on the therapeutic efficacy of both S-1 mono-therapy and oxaliplatin plus capecitabine regimen in ACTS-gastric cancer (GC) and CLASSIC study, we conducted the multi-institutional research using propensity score-matched analysis to evaluate whether patients after D2 resection benefit from adjuvant chemotherapy with S-1 plus oxaliplatin (SOX). Here, we firstly report that SOX adjuvant chemotherapy, compared with surgery alone, significantly improves disease-free survival and overall survival in stage IB-IIIC GC patients undergoing D2 resection with accepted side effects.