Abstract

BackgroundAdjuvant tegafur-gimeracil-oteracil (S-1) is commonly used for gastric cancer in Asia, and tegafur-uracil (UFT) is another oral fluoropyrimidine when S-1 is unavailable. The real-world data of adjuvant UFT has less been investigated.MethodsPatients with pathological stage II-IIIB (except T1) gastric cancer receiving adjuvant UFT or S-1 monotherapy after D2 gastrectomy were included. Usage of UFT or S-1 was based on reimbursement policy of the Taiwanese healthcare system. The characteristics, chemotherapy completion rates, and 5-year recurrence-free survival (RFS) and overall survival (OS), were compared between these two groups.ResultsFrom 2005 to 2016, 86 eligible patients were included. Most tumor characteristics were similar between the UFT group (n = 37; age 59.1 ± 13.9 years) and S-1 group (n = 49; age 56.3 ± 10.7 years), except there were significantly more Borrmann type III/IV (86.5% versus 67.3%; p = 0.047) and T4 (56.8% versus 10.2%; p < 0.001) lesions in the UFT group than in the S-1 group. The chemotherapy complete rates were similar in the two groups. The 5-year RFS was 56.1% in the UFT group and 59.6% in the S-1 group (p = 0.71), and the 5-year OS was 78.3% in the UFT group and 73.1% in the S-1 group (p = 0.48). The hazard ratio of adjuvant chemotherapy (S-1 versus UFT) on RFS was 1.25 (95% confidence interval = 0.53-2.94) when Borrmann type and T and N stages were adjusted.ConclusionsThis small cohort study showed adjuvant UFT, and S-1 monotherapy had a comparable long-term outcome for pathological stage II-IIIB gastric cancer following D2 gastrectomy.

Highlights

  • Adjuvant tegafur-gimeracil-oteracil (S-1) is commonly used for gastric cancer in Asia, and tegafururacil (UFT) is another oral fluoropyrimidine when S-1 is unavailable

  • Radical gastrectomy with lymph node dissection is the treatment of choice for resectable gastric cancer [2], and adjuvant chemotherapy is recommended for pathological stage II-IIIB gastric cancer based on several randomized controlled trials (RCTs), Japanese gastric cancer treatment guidelines, and Korean practice guideline for gastric cancer [3,4,5,6,7,8,9,10,11,12]

  • Dihydropyrimidine dehydrogenase (DPD) inhibitory fluoropyrimidine (DIF), the oral form prodrug of 5flurouracil (5-FU), has been developed since 1980 [10], and is currently the most important chemotherapeutic agent used in adjuvant chemotherapy for advanced gastric cancer

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Summary

Introduction

Adjuvant tegafur-gimeracil-oteracil (S-1) is commonly used for gastric cancer in Asia, and tegafururacil (UFT) is another oral fluoropyrimidine when S-1 is unavailable. In Taiwan, UFT was approved for advanced gastric cancer and reimbursed by the Taiwanese healthcare system in October 2000; on the other hand, S-1 was approved for advanced gastric cancer based on the same inclusion criteria in the ACTS-GC in April 2010 but was not reimbursed until December 2016. Both UFT and S-1 are indicated for advanced gastric cancer as adjuvant monotherapy in Taiwan, realworld experiences and comparisons of efficacy and tolerance between these two oral DPD DIFs remain suboptimal and are only limited to sub-group analysis in one clinical trial, the Stomach cancer Adjuvant Multi-Institutional group Trial (SAMIT) [15]

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