Clinical Analysis of Postoperative Adjuvant Therapy in Gastric Cancer
Abstract: Objective: To analyze the response and side effects of postoperative adjuvant therapy in gastric cancer. Methods: From January 2005 to September 2012, 156 patients with gastic cancinoma re-ceived the treatment in our hospital, 94 male, 62 female. The average age is 58.2 years (23 to 84 years, median 58 years). All the cases were pathologically confirmed gastric cancer. According to the 7th edition AJCC staging, IA, 7 cases; IB, 7 cases; IIA, 6 cases; IIB, 19 cases; IIIA, 25 cases; IIIB, 34 cases; IIIC, 44 cases; IV, 12 cases; 2 cases were unknown. All 156 cases have adopted radical resection. 12 cases did not undergo any chemotherapy after surgery; 142 cases received postoperative chemotherapy, 64 cases were treated with docetaxel + platinum + fluorouracil (DCF) or epirubicin + platinum + fluorouracil (ECF) three-drug regimen; 66 cases were treated with platinum + fluorouracil two-drug regimen; 9 cases with oral S1 or capecitabine chemotherapy; one case with only intraperitoneal infusion of platinum + fluorouracil; two cases, unknown chemotherapy regimen. 28 patients received postoperative radiotherapy. Results: The median follow-up was 36.5 months. 3-year overall survival rate was 53.5%; 3-year local control rate was 82.0%; 3-year distant metastasis rate was 53.8%. Univariate analysis showed that T stage (T1-3 or T4), N stage (N0-1 or N2-3), postoperative stage (I-II or III-IV) were statistically significant with local control and overall survival (P < 0.05 for all) and that lymphatic invasion had impact on distant metastasis (P=0.036). In postoperative chemotherapy, the use of three-drug regimen is superior to the two-drug regimen on overall survival (P=0.047). Conclusions: The overall effect of treatment in gastric cancer remains poor. Postoperative chemotherapy using DCF/ECF three-drug regimen might have an advantage on overall survival.
文章引用: 王妹兴 , 肖 谜 , 蒋 娉 , 王月琴 , 李云海 (2015) 胃癌根治术后辅助治疗的临床分析。 亚洲肿瘤科病例研究， 4， 32-38. doi: 10.12677/ACRPO.2015.44006
Kamangar, F., Dores, G.M. and Anderson, W.F. (2006) Patterns of Cancer Incidence, Mortality, and Prevalence across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World. Jour- nal of Clinical Oncology, 24, 2137-2150.
 陈万青, 张思维, 曾红梅, 等. 中国2010年恶性肿瘤发病与死亡[J]. 中国肿瘤, 2014, 23(1): 1-10.
Siegel, R., Ma, J., Zou, Z., et al. (2014) Cancer Statistics, 2014. CA: A Cancer Journal for Clinicians, 64, 9-29.
Hundahl, S.A., Phillips, J.L. and Menck, H.R. (2000) The National Cancer Data Base Report on Poor Survival of US Gastric Carcinoma Patients Treated with Gastrectomy: Fifth Edition American Joint Committee on Cancer stAging, Proximal Disease, and the “Different Disease” Hypothesis. Cancer, 88, 921-932.
 詹友庆, 孙晓卫, 李威, 等. 影响根治术后胃癌预后的多因素分析[J]. 癌症, 2005, 24(5): 596-599.
Nashimoto, A., Nakajima, T., Furukawa, H., et al. (2003) Randomized Trial of Adjuvant Chemotherapy with Mitomycin, Fluorouracil, and Cytosine Arabinoside Followed by Oral Fluorouracil in Serosa-Negative Gastric Cancer: Japan Clinical Oncology Group 9206-1. Journal of Clinical Oncology, 21, 2282-2287.
Bouché, O., Ychou, M., Burtin, P., et al. (2005) Adjuvant Chemotherapy with 5-Fluorouracil and Cisplatin Compared with Surgery Alone for Gastric Cancer: 7-Year Results of the FFCD Randomized Phase III Trial (8801). Annals of Oncology, 16, 1488-1497.
De Vita, F., Giuliani, F., Orditura, M., et al. (2007) Adjuvant Chemotherapy with Epirubicin, Leucovorin, 5-Fluorou- racil and Etoposide Regimen in Resected Gastric Cancer Patients: A Randomized Phase III Trial by the Gruppo Oncologico Italia Meridionale (GOIM 9602 Study). Annals of Oncology, 18, 1354-1358.
Di Costanzo, F., Gasperoni, S., Manzione, L., et al. (2008) Adjuvant Chemotherapy in Completely Resected Gastric Cancer: A Randomized Phase III Trial Conducted by GOIRC. Journal of the National Cancer Institute, 100, 388-398.
Kulig, J., Kolodziejczyk, P., Sierzega, M., et al. (2010) Adjuvant Chemotherapy with Etoposide, Adriamycin and Cisplatin Compared with Surgery Alone in the Treatment of Gastric Cancer: A Phase III Randomized, Multicenter, Clinical Trial. Oncology, 78, 54-61.
Sakuramoto, S., Sasako, M., Yamaguchi, T., et al. (2007) Adjuvant Chemotherapy for Gastric Cancer with S-1, an Oral Fluoropyrimidine. The New England Journal of Medicine, 357, 1810-1820.
Bang, Y.J., Kim, Y.W., Yang, H.K., et al. (2012) Adjuvant Capecitabine and Oxaliplatin for Gastric Cancer after D2 Gastrectomy (CLASSIC): A Phase 3 Open-Label, Randomised Controlled Trial. Lancet, 379, 315-321.
Webb, A., Cunningham, D., Scarffe, J.H., et al. (1997) Randomized Trial Comparing Epirubicin, Cisplatin, and Fluorouracil versus Fluorouracil, Doxorubicin, and Methotrexate in Advanced Esophagogastric Cancer. Journal of Clinical Oncology, 15, 261-267.
Ross, P., Nicolson, M., Cunningham, D., et al. (2002) Prospective Randomized trial Comparing Mitomycin, Cisplatin, and Protracted Venous-Infusion Fluorouracil (PVI 5-FU) with Epirubicin, Cisplatin, and PVI 5-FU in Advanced Esophagogastric Cancer. Journal of Clinical Oncology, 20, 1996-2004.
Van Cutsem, E., Moiseyenko, V.M., Tjulandin, S., et al. (2006) Phase III Study of Docetaxel and Cisplatin plus Fluorouracil Compared with Cisplatin and Fluorouracil as First-Line Therapy for Advanced Gastric Cancer: A Report of the V325 Study Group. Journal of Clinical Oncology, 24, 4991-4997.
Roth, A.D., Fazio, N., Stupp, R., et al. (2007) Docetaxel, Cisplatin, and Fluorouracil; Docetaxel and Cisplatin; and Epirubicin, Cisplatin, and Fluorouracil as Systemic Treatment for Advanced Gastric Carcinoma: A Randomized Phase II trial of the Swiss Group for Clinical Cancer Research. Journal of Clinical Oncology, 25, 3217-3223.
Macdonald, J.S., Smalley, S.R., Benedetti, J., et al. (2001) Chemoradiotherapy after Surgery Compared with Surgery Alone for Adenocarcinoma of the Stomach or Gastroesophageal Junction. The New England Journal of Medicine, 345, 725-730.
Lee, J., Lim do, H., Kim, S., et al. (2012) Phase III Trial Comparing Capecitabine plus Cisplatin versus Capecitabine plus Cisplatin with Concurrent Capecitabine Radiotherapy in Completely Resected Gastric Cancer with D2 Lymph Node Dissection: The ARTIST Trial. Journal of Clinical Oncology, 30, 268-273.