Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study

Lee, Chang Min; Yoo, Myoung-Woo; Son, Young Hoon; Oh, Sung Jin; Kim, Jong Han; Kim, Wook; Park, Joong Min; Hur, Hoon; Jee, Ye Seob; Hwang, Sun-Hwi; Jin, Sung Ho; Lee, Sang Eok; Park, Ji Ho; Seo, Kyung Won; Kim, Chang‐Hyun; Jeong, In Ho; Lee, Han Hong; Choi, Sung Il; Lee, Sang Il; Kim, Chan Young; Kim, In Hwan; Son, Myoung Won; Pak, Kyung Ho; Kim, Sung Soo; Lee, Moon Soo; Min, Jae Seok

doi:10.5230/jgc.2020.20.e13

Cited by 11 publications

(29 citation statements)

References 15 publications

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Section: Discussioncontrasting

confidence: 56%

“…The researchers found that pathologic T and N stages and completion of planned chemotherapy were prognostic factors for recurrence. 20 Although there was a significant difference in OS between XELOX and TS-1 groups of stage II patients in our cohort, there was no significant difference in stages IIIA-IIIC, and no significant difference in DFS was found between the 2 groups at any stage. These survival discrepancies among previous studies might be due to different AJCC stages (seventh or eighth), treatment compliance of patients, slight differences in planned adjuvant chemotherapy completion rates, dose reduction, and duration of chemotherapy.…”

Section: Discussioncontrasting

confidence: 56%

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Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Choi

et al. 2021

Technol Cancer Res Treat

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Purpose: Various adjuvant chemotherapies have been introduced for gastric cancer patients after gastrectomy with D2 lymph node dissection. Although the mainstream regimen of adjuvant chemotherapy in Korea includes S-1 monotherapy (TS-1) and capecitabine with oxaliplatin (XELOX), few studies have compared the long-term efficacies of these 2 regimens. Methods: Between January 2010 and June 2017, 2021 patients were diagnosed with gastric cancer and underwent curative resection with adjuvant chemotherapy at our institution. Of 1461 patients with stage IB-III gastric cancer, 825 received TS-1 and 636 received XELOX as adjuvant chemotherapy. We retrospectively reviewed their medical records and analyzed the postoperative 5-year overall survival (OS) and disease-free survival (DFS) of these 2 groups. Results: The patients in the XELOX group had more advanced stage of cancer than the TS-1 group (stages III and II: 56.6% and 43.1%, respectively, in XELOX and 35.3% and 57.0% in TS-1; P < .001). The DFS did not differ significantly between the 2 study groups at any pathologic stage. The OS differed significantly only at pathologic stages IIA ( P = .024) and IIB ( P = .015). In a multivariate analysis of stage II patients, type of regimen was an independent prognostic factor of OS (XELOX vs TS-1; hazard ratio: 0.47, 95% confidence interval: 0.25-0.89, P = .021). Conclusion: There were similar long-term efficacies between these 2 regimens in advanced gastric cancer patients who underwent curative surgery. However, the XELOX regimen might be favorable for OS of stage II patients.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussioncontrasting

confidence: 56%

Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Choi

et al. 2021

Technol Cancer Res Treat

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“…Among these, we excluded 6741 studies since they were reviews, books, or meta-analyses, and we included 11,880 clinical trials and randomized controlled studies. Based on the titles and abstracts of the 11,875 studies, five clinical studies comparing S-1 versus CAPOX as AC in patients undergoing gastrectomy were selected [ 14 , 15 , 16 , 17 , 18 ]. Two of these studies were excluded because they collected data from a relatively short-term three-year follow-up after gastrectomy [ 14 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Among the studies comparing three-year postoperative survival, a multicenter propensity score matching (PSM) study showed that adjuvant CAPOX chemotherapy was more effective than S-1 for stage IIIB or IIIC gastric cancer [ 14 ]. On the other hand, among the studies analyzing five-year postoperative survival, two studies that conducted PSM showed comparable oncologic outcomes between the two regimens [ 15 , 16 ]. A single-center, observational study presented the potential for superior efficacy of the CAPOX regimen against stage II gastric cancer [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of S-1 or Capecitabine Plus Oxaliplatin Adjuvant Chemotherapy for Stage II or III Gastric Cancer after Curative Gastrectomy: A Systematic Review and Meta-Analysis

Jeong

Kim

et al. 2022

Cancers

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Background: Adjuvant chemotherapy (AC) regimens tegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) have predominated, however, there has been a lack of studies on their differences in efficacy. Methods: We conducted pairwise meta-analyses comparing the efficacy of S-1 and CAPOX regimens for overall survival (OS) and disease-free survival (DFS) in stage II or III GC patients. Results: Three studies were enrolled and analyzed using a forest plot for meta-analysis. Two of them were propensity score matching studies, and the remaining one was a retrospective observational study. In all stages, the five-year OS was not different between the two regimens (HR 0.96, 95% CI 0.78–1.17; p = 0.56). Additionally, the 5-year DFS was not different at any stage (HR 1.00, 95% CI 0.85–1.18; p = 0.21). After omitting the retrospective observational study, the five-year OS (HR 1.40, 95% CI 0.53–3.73) and DFS (HR 1.41, 95% CI 0.57–3.44) of S-1 tended to be better in stage II, and the five-year OS (HR 0.81, 95% CI 0.56–1.16) and DFS (HR 0.85, 95% CI 0.63–1.13) of CAPOX tended to be better in stage III, without statistical significance. Conclusions: In the present meta-analysis, the five-year OS and DFS for stage II or III GC patients were comparable between S-1 and CAPOX regimens as AC.

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“…In this study, the S-1 completion rate was higher than the CAPOX completion rate, although the difference was not statistically significant. AC compliance is a prognostic factor for recurrence [ 17 ]. An ACTS-GC trial post-hoc analysis showed that patients who completed AC had better survival than those who did not [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival Outcomes of Elderly Patients Treated With S-1 or Capecitabine Plus Oxaliplatin for Stage II or III Gastric Cancer: A Multicenter Cohort Study

et al. 2022

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Purpose Tegafur/gimeracil/oteracil (S-1) and capecitabine plus oxaliplatin (CAPOX) are standard adjuvant chemotherapies (ACs) administered after gastrectomy to patients with stage II or III gastric cancer. However, the efficacy of AC in elderly patients remains unclear. The objective of this retrospective multicenter cohort study was to compare the efficacies of S-1 and CAPOX AC in patients aged ≥70 years. Materials and Methods Nine hundred eighty-three patients who were treated with AC using S-1 (768 patients) or CAPOX (215 patients) were enrolled in this study. Each patient underwent AC after curative gastrectomy for stage II or III gastric cancer at one of 27 hospitals in the Republic of Korea between January 2012 and December 2013. Relapse-free survival (RFS) and overall survival (OS) were analyzed according to AC regimen and age group. Results Of the 983 patients, 254 (25.8%) were elderly. This group had a similar RFS (P=0.099) but significantly poorer OS (p=0.003) compared with the non-elderly group. Subgroup analysis of the non-elderly group revealed no AC-associated differences in survival. Subgroup analysis of the elderly group revealed significantly better survival in the S-1 group than in the CAPOX group (RFS, P<0.001; OS, P<0.001). Multivariate analysis revealed that the CAPOX regimen was an independent poor prognostic factor for RFS (hazard ratio [HR], 1.891; 95% confidence interval [CI], 1.072–3.333; P=0.028) and OS (HR, 2.970; 95% CI, 1.550–5.692; P=0.001). Conclusions This multicenter observational cohort study found significant differences in RFS and OS between S-1 and CAPOX AC among patients with gastric cancer aged ≥70 years.

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Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study

Abstract: Purpose: To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC).

Cited by 11 publications

References 15 publications

Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study

Efficacy of S-1 or Capecitabine Plus Oxaliplatin Adjuvant Chemotherapy for Stage II or III Gastric Cancer after Curative Gastrectomy: A Systematic Review and Meta-Analysis

Long-Term Survival Outcomes of Elderly Patients Treated With S-1 or Capecitabine Plus Oxaliplatin for Stage II or III Gastric Cancer: A Multicenter Cohort Study

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