Abstract
BackgroundTo evaluate whether the addition of taxanes to platinum and fluoropyrimidines in adjuvant chemotherapy would result in longer survival than platinum plus fluoropyrimidines in gastric cancer patients who received D2 gastrectomy.MethodsData of patients with gastric adenocarcinoma who received D2 gastrectomy and adjuvant chemotherapy with platinum plus fluoropyrimidines or taxanes, platinum plus fluoropyrimidines was retrospectively collected and analyzed. 1:1 Propensity score matching analysis was used to balance baseline characteristics between two groups. Survival curves were estimated using Kaplan-Meier method, and the differences were compared using the log-rank test.ResultsFour hundred twenty-five patients in the platinum plus fluoropyrimidines group and 177 patients in the taxanes, platinum plus fluoropyrimidines group were included into analysis. No statistical differences in disease-free survival and overall survival were observed between two groups. After propensity score matching, 172 couples of patients were matched, the baseline characteristics were balanced. The median disease-free survival were 15.8 months (95% CI, 9.3~22.4) in the platinum plus fluoropyrimidines group and 22.6 months (95% CI, 15.9~29.4) in the taxanes, platinum plus fluoropyrimidines group (HR = 0.63; 95% CI, 0.48~0.85; P = 0.002). The median overall survival was 25.4 months for patients in the platinum plus fluoropyrimidines group (95% CI, 19.4~31.3) and 33.8 months (95% CI, 23.5~44.2) for those in the taxanes, platinum plus fluoropyrimidines group (HR = 0.68; 95% CI, 0.53-0.87; log-rank test, P = 0.002).ConclusionsFor gastric adenocarcinoma patients, the adjuvant triplet combination of taxanes, platinum, and fluoropyrimidines regimen after D2 gastrectomy was superior to platinum plus fluoropyrimidines regimen in disease-free survival as well as overall survival.Trial registrationThis project has been registered in the Chinese Clinical Trial Registry (ChiCTR1800019978).
Highlights
It is estimated that there are more than 1 million incident gastric cancer cases worldwide every year, of which 44% were diagnosed in China [1]
For gastric adenocarcinoma patients, the adjuvant triplet combination of taxanes, platinum, and fluoropyrimidines regimen after D2 gastrectomy was superior to platinum plus fluoropyrimidines regimen in disease-free survival as well as overall survival
All patients included in the study met the following criteria: underwent curative D2 gastrectomy followed by adjuvant chemotherapy; with detailed postoperative pathological report and could be staged according to the American Joint Committee on Cancer (AJCC) seventh staging system [12]; with definite medical records of radiological followup after surgical resection; received at least one cycle of systemic adjuvant chemotherapy; adjuvant chemotherapeutic regimens should be either doublet combination of platinum and fluoropyrimidines or triplet combination of taxanes, platinum, and fluoropyrimidines
Summary
It is estimated that there are more than 1 million incident gastric cancer cases worldwide every year, of which 44% were diagnosed in China [1]. Monotherapy S1 or doublet oxalipatin plus capecitabine regimens were frequently used in adjuvant settings [3,4,5,6,7]. In actual clinical practice, varied doublet combinations of platinum (oxalipatin, cisplatin, or lobaplatin) with fluoropyrimidines (intravenous 5-fluorouracil, oral capecitabine or S1) were all universally acceptable adjuvant regimens. Taxanes, which mainly refer to docetaxel and paclitaxel, are effective in gastric cancer treatment and were tested in adjuvant settings. Whether the addition of docetaxel or paclitaxel to the traditional combination of platinum and fluoropyrimidines as adjuvant regimen could improve survival for gastric cancer had not been explored in clinical trials. To evaluate whether the addition of taxanes to platinum and fluoropyrimidines in adjuvant chemotherapy would result in longer survival than platinum plus fluoropyrimidines in gastric cancer patients who received D2 gastrectomy
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