Risk Factors and Prognostic Impact of the Completion of Adjuvant Chemotherapy with Oxaliplatin Plus Oral Fluorouracil for AGC After D2 Gastrectomy

Abstract

Background: To analyze the risk factors and prognostic impact of the completion of adjuvant chemotherapy with oxaliplatin plus oral fluorouracil for advanced gastric cancer (AGC) after D2 gastrectomy.Methods: A total of 234 patients with AGC who underwent D2 gastrectomy and received oxaliplatin plus oral fluorouracil adjuvant chemotherapy between January 1, 2012 to January 1, 2021 in the First Affiliated Hospital of Xiamen University were identified (203 cases with SOX regime;31 cases with XELOX regime) and their clinicopathological information was retrospectively analyzed. The tolerability and safety of oxaliplatin plus oral fluorouracil therapy were analyzed. Patients were divided into high completion group (n = 135) and low completion group (n = 99) according to whether they had completed 6 cycles of adjuvant combined chemotherapy. Relevant risk factors and the prognostic impact of the completion rates of chemotherapy were analyzed.Results: 99 patients have completed more than 6 cycles of adjuvant chemotherapy with oxaliplatin plus oral fluorouracil and the chemotherapy completion rate was 42.31%. Chemotherapy completion was correlated with age ( P = 0.000) and the extent of gastric resection ( P = 0.039). Age was independent risk factor of chemotherapy completion ( OR ,2.487; 95%CI ,1.449-4.268; P = 0.001). As of January 1,2021, 124 patients were followed up for more than three years, the three-year survival rate (86.9% vs 68.8%; P = 0.02) were significantly different between two groups, and the differences of pN stage, pTNM stage and nerve invasion were also statistically significant ( P < 0.05, respectively). Cox regression analysis showed that pN3 stage ( HR ,2.645; 95%CI ,1.138-6.146 ; P = 0.024) was independent prognostic factor about poor survival.Conclusions: Oxaliplatin plus fluorouracil oral adjuvant chemotherapy was safe and tolerable. Advanced age and total gastrectomy were risk factors for chemotherapy completion. The key to improve the prognosis of patients with AGC after D2 gastrectomy was to improve the completion rate of adjuvant chemotherapy.