Outcome predictors for patients with stage II/III gastric cancer who undergo gastrectomy and S-1 adjuvant chemotherapy

Abstract

Abstract. Predictors of survival in patients with stage II/III gastric cancer (GC) who received tegafur/gimeracil/oteracil (S-1) adjuvant chemotherapy (ACT) subsequent to gastrectomy were examined. Additionally, the association between dose intensity of S-1 and survival rate was investigated. A total of 62 patients with stage II/III gastric cancer were retrospectively evaluated, each of whom had received a curative D2 gastrectomy and S-1 ACT. The relative performance (RP; administered/planned S-1 doses x100%), body mass index (BMI), prognostic nutritional index (PNI) and body weight (BW) were calculated, and the association of survival with these factors and other clinicopathological parameters was examined. The 1-year treatment continuation rate for S-1 was 94.2%, excluding patients who experienced cancer recurrences during their ACT year. The initial S-1 reduction rate was 38.7%. Patients with stage II/IIIA disease exhibited significantly improved 5-year overall survival rates compared with patients with stage IIIB GC, 81.6/73.7 vs. 33.8% (P<0.01). No association between RP and survival was observed. BMI, BW and PNI were significantly decreased following surgery compared with preoperative states. In the univariate analysis, postoperative BW loss (BMI loss), pathological stage and >7 lymph node metastases were significantly associated with outcome (P<0.05); in the multivariate analysis, postoperative BW loss >10.6% and pathological stages were independent prognostic factors for survival. Continuing S-1 ACT for the full year exhibited a greater effect on survival compared with dosage. Early postoperative nutritional deterioration may decrease the survival rates in these patients.

Early Weight Loss as a Prognostic Factor in Patients with Advanced Gastric Cancer: Analyses from REGARD, RAINBOW, and RAINFALL Phase III Studies

“…Weight loss can be described both in severity and in timing. Pre-operative weight loss and nutritional deficiency are well-established prognostic factors in patients with G/GEA (12,28). Weight loss of ≥10% before diagnosis has been shown to be a significant negative prognostic factor for OS in patients with advanced G/GEA undergoing second-line chemotherapy (29).…”

Systematic Review of Prognostic Role of Blood Cell Ratios in Patients with Gastric Cancer Undergoing Surgery

“…PNI was investigated by 19 studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. A high PNI is hypothesized to be associated with a longer survival.…”

“…Twelve studies analyzed PNI for OS [22][23][24][25][26][27][28][29][30][31][32]40]. In 10 studies, a high PNI was significantly associated with a longer OS, whereas in two studies there was no significant association (Figure 3A and Table 3).…”

Nutritional and Clinical Factors Affecting Weight and Fat-Free Mass Loss after Gastrectomy in Patients with Gastric Cancer

“…The magnitude of weight loss was different between gastrectomy and chemotherapy. Weight loss was significantly lower in patients who had a proximal resection, laparoscopy, or no chemotherapy [ 31 , 32 ]. In our study, weight loss was affected by factors such as female gender and chemotherapy administered one to three months and three to six months after surgery.…”