AIM To investigate the safety and efficacy of S-1 plus oxaliplatin(SOX) as an adjuvant chemotherapy regimen in gastric cancer(GC) after D2 dissection.METHODS GC Patients who underwent D2 gastrectomy from September 200...AIM To investigate the safety and efficacy of S-1 plus oxaliplatin(SOX) as an adjuvant chemotherapy regimen in gastric cancer(GC) after D2 dissection.METHODS 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%).CONCLUSION 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.展开更多
Background:A fixed 8-cycle oxaliplatin and capecitabine(XELOX)regimen has been the standard adjuvant therapy for patients with stage III colon cancer.However,completing the full-cycle of oxaliplatin is often associate...Background:A fixed 8-cycle oxaliplatin and capecitabine(XELOX)regimen has been the standard adjuvant therapy for patients with stage III colon cancer.However,completing the full-cycle of oxaliplatin is often associated with severe neurotoxicity.To spare patients from the toxic effects,without comprising the required efficacy,we evaluated the safety and efficacy of a modified XELOX(mXELOX)adjuvant chemotherapy regimen with 6 cycles of oxaliplatin and a full cycle of capecitabine.Methods:We retrospectively analyzed 330 eligible patients with stage III colon cancer who underwent cura-tive tumor resection followed by mXELOX,standard XELOX or unfinished XELOX adjuvant chemotherapy between December 2007 and April 2015.Associated prognostic factors were investigated and their disease-free survival(DFS)and overall survival(OS)rates were also determined and compared among the different regimen groups.Results:Compared with the standard XELOX group,the mXELOX group had lower total incidence rates of neuro-toxicity(39.3%vs.76.2%,P<0.001),leucopenia(53.6%vs.69.8%,P=0.017)and thrombocytopenia(38.1%vs.56.3%,P=0.011).The standard XELOX and mXELOX adjuvant chemotherapy regimens presented with comparable 3-year DFS rates(86.3%vs.89.2%;P=0.838)and 3-year OS rates(92.7%vs.97.6%;P=0.227).Compared to unfinished XELOX chemotherapy,the oncologic benefits of the mXELOX regimen were greater for patients with T4 tumors(3-year DFS:Hazard ratio[HR],2.184;95%confidence interval[CI],1.051-4.540;P=0.036;3-year OS:HR,4.529;95%CI 1.245-16.479;P=0.022)and for high-risk patients(3-year DFS:HR,1.962;95%CI 0.964-3.993;P=0.044;3-year OS:HR,4.193;95%CI 1.182-14.874;P=0.026).Conclusions:The mXELOX adjuvant chemotherapy presented a comparable survival benefit and lower incidence of toxicity than standard XELOX chemotherapy.It could be an alternative treatment for high-risk patients with operated stage III colon cancer.展开更多
基金Supported by the Thousand Talents of Program of High-end Innovation of Qinghai Province in China(For Jiuda Zhao)the Clinical Oncology Medical Center of Qinghai Province in China,No.2018-SF-113
文摘AIM To investigate the safety and efficacy of S-1 plus oxaliplatin(SOX) as an adjuvant chemotherapy regimen in gastric cancer(GC) after D2 dissection.METHODS 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%).CONCLUSION 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.
基金This work was funded by grants from National Natural Science Foundation of China(Grant No.81772595)Sun Yat-sen University Clinical Research 5010 Program(2015024)+1 种基金Sun Yat-sen University Clinical Research 5010 Program(2013013)Guangzhou Science and Technology Plan Projects(Health Medical Collaborative Innovation Program of Guangzhou)(Grant No.201803040019)
文摘Background:A fixed 8-cycle oxaliplatin and capecitabine(XELOX)regimen has been the standard adjuvant therapy for patients with stage III colon cancer.However,completing the full-cycle of oxaliplatin is often associated with severe neurotoxicity.To spare patients from the toxic effects,without comprising the required efficacy,we evaluated the safety and efficacy of a modified XELOX(mXELOX)adjuvant chemotherapy regimen with 6 cycles of oxaliplatin and a full cycle of capecitabine.Methods:We retrospectively analyzed 330 eligible patients with stage III colon cancer who underwent cura-tive tumor resection followed by mXELOX,standard XELOX or unfinished XELOX adjuvant chemotherapy between December 2007 and April 2015.Associated prognostic factors were investigated and their disease-free survival(DFS)and overall survival(OS)rates were also determined and compared among the different regimen groups.Results:Compared with the standard XELOX group,the mXELOX group had lower total incidence rates of neuro-toxicity(39.3%vs.76.2%,P<0.001),leucopenia(53.6%vs.69.8%,P=0.017)and thrombocytopenia(38.1%vs.56.3%,P=0.011).The standard XELOX and mXELOX adjuvant chemotherapy regimens presented with comparable 3-year DFS rates(86.3%vs.89.2%;P=0.838)and 3-year OS rates(92.7%vs.97.6%;P=0.227).Compared to unfinished XELOX chemotherapy,the oncologic benefits of the mXELOX regimen were greater for patients with T4 tumors(3-year DFS:Hazard ratio[HR],2.184;95%confidence interval[CI],1.051-4.540;P=0.036;3-year OS:HR,4.529;95%CI 1.245-16.479;P=0.022)and for high-risk patients(3-year DFS:HR,1.962;95%CI 0.964-3.993;P=0.044;3-year OS:HR,4.193;95%CI 1.182-14.874;P=0.026).Conclusions:The mXELOX adjuvant chemotherapy presented a comparable survival benefit and lower incidence of toxicity than standard XELOX chemotherapy.It could be an alternative treatment for high-risk patients with operated stage III colon cancer.
