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Efficacy of Adjuvant S-1 Versus XELOX Chemotherapy for Patients with Gastric Cancer After D2 Lymph Node Dissection: A Retrospective, Multi-Center Observational Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

After curative resection of gastric cancer with D2 lymph node dissection, postoperative adjuvant chemotherapy with S-1 or capecitabine plus oxaliplatin (XELOX) is considered to be standard therapy in Eastern countries. This study aimed to compare the efficacies of adjuvant S-1 and XELOX chemotherapy for gastric cancer patients after D2 dissection based on disease-free survival (DFS).

Methods

This retrospective observational study was conducted at 29 tertiary hospitals in Korea. Of 1898 patients who underwent curative resection and received adjuvant chemotherapy for gastric cancer between February 2012 and December 2013, 1088 patients who met the eligibility criteria were enrolled in the study. After propensity score-matching, the 3-year disease-free survival rate (DFS) was used to compare efficacies directly between adjuvant XELOX and S-1 chemotherapies for patients with stage 2 or 3 gastric cancer after D2 gastrectomy.

Results

The 3-year DFS rates for the S-1 and XELOX groups did not differ significantly among disease stages 2A, 2B, and 3A (all p > 0.05). However, the survival rates for the S-1 group were significantly lower than for the XELOX group for stage 3B (65.8% vs. 68.6%; p = 0.019) and stage 3C (48.4% vs. 66.7%; p = 0.002) gastric cancer. The hazard ratios (HRs) of S-1 chemotherapy for recurrence compared with XELOX for stages 3B and 3C were respectively 2.030 [95% confidence interval (CI), 1.110–3.715; p = 0.022] and 2.732 (95% CI 1.427–5.234; p = 0.002).

Conclusions

Adjuvant XELOX chemotherapy was more effective than S-1 for patients with stage 3B or 3C gastric cancer after D2 lymph node dissection.

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Acknowledgment

We especially thank Wan-Sik Yu, MD, Oh-Kyung Kwon, MD, Seung-Su Lee, MD, Sang-Eok Lee, MD, Young-Jun Lee, MD, Sang-Ho Jung, MD, Sung-Il Choi, MD, Seung-Wan Ryu, MD, Jong-Seok Kim, MD, Seong-Heum Park, MD, Jong-Han Kim, MD, Ye-Seob Ji, MD, Il-Myoung Kim, MD, Soon-Hwi Hwang, MD, Jun-Hyun Lee, MD, Do-Joog Park, MD, Moon-Won Yu, MD, Sang-Uk Han, MD, Yong-Kwan Jo, MD, Hang-Jong Yu, MD, Jong-In Lee, MD, Sung-Ho Jin, MD, Jin-Jo Kim, MD, Seung-Man Park, MD, Sung-Su Kim, MD, Joong-Min Park, MD, Min-Kyu Kim, MD, and all members of the Surgical Oncology Forum (SOF) of Korea for collaboration, discussion, and data-sharing for this study.

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Authors and Affiliations

  1. Department of Surgery, Daegu Catholic University School of Medicine, Daegu, South Korea

    In-Hwan Kim MD, PhD & Hyundong Chae MD, PhD

  2. Department of Surgery, Korea University College of Medicine and School of Medicine, Seoul, South Korea

    Sung-Soo Park MD, PhD & Chang-Min Lee MD, PhD

  3. Department of Surgery, Dong-A University School of Medicine, Busan, South Korea

    Min Chan Kim MD, PhD

  4. Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea

    In-Kyu Kwon MD, PhD

  5. Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, South Korea

    Jae-Seok Min MD, PhD

  6. Department of Surgery, Yonsei University School of Medicine, Seoul, South Korea

    Hyoung-Il Kim MD, PhD

  7. Department of Surgery, Seoul St. Mary’s Hospital, Seoul, South Korea

    Han Hong Lee MD, PhD

  8. Department of Surgery, Chungnam National University School of Medicine, Daejeon, South Korea

    Sang-Il Lee MD, PhD

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  1. In-Hwan Kim MD, PhD
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  2. Sung-Soo Park MD, PhD
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  3. Chang-Min Lee MD, PhD
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  4. Min Chan Kim MD, PhD
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  5. In-Kyu Kwon MD, PhD
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  6. Jae-Seok Min MD, PhD
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  7. Hyoung-Il Kim MD, PhD
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  8. Han Hong Lee MD, PhD
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  9. Sang-Il Lee MD, PhD
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  10. Hyundong Chae MD, PhD
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Corresponding author

Correspondence to Hyundong Chae MD, PhD.

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Kim, IH., Park, SS., Lee, CM. et al. Efficacy of Adjuvant S-1 Versus XELOX Chemotherapy for Patients with Gastric Cancer After D2 Lymph Node Dissection: A Retrospective, Multi-Center Observational Study. Ann Surg Oncol 25, 1176–1183 (2018). https://doi.org/10.1245/s10434-018-6375-z

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  • DOI: https://doi.org/10.1245/s10434-018-6375-z

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