Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy.
BACKGROUND: A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy am...
Main Authors: | , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2013-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC3554736?pdf=render |
_version_ | 1819041883016396800 |
---|---|
author | Ying Jin Miao-zhen Qiu De-shen Wang Dong-sheng Zhang Chao Ren Long Bai Hui-yan Luo Zhi-qiang Wang Feng-hua Wang Yu-hong Li Rui-hua Xu |
author_facet | Ying Jin Miao-zhen Qiu De-shen Wang Dong-sheng Zhang Chao Ren Long Bai Hui-yan Luo Zhi-qiang Wang Feng-hua Wang Yu-hong Li Rui-hua Xu |
author_sort | Ying Jin |
collection | DOAJ |
description | BACKGROUND: A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival. METHODS: We retrospectively reviewed 360 patients who had undergone D2 gastrectomy, aged 65 years or older, with non-metastatic gastric cancer in a single institution. We analyzed the predictors and survival benefits of adjuvant chemotherapy use in the elderly. Further, we analyzed the survival benefits of adjuvant chemotherapy by dividing the patients into groups according to disease stages and chemotherapeutic regimens. RESULTS: Among the 360 patients, only 34.7% of patients received adjuvant chemotherapy. Age, tumor location, lymph node involvement and tumor invasion were associated with the receipt of adjuvant chemotherapy. Adjuvant chemotherapy improved the overall survival for non-metastatic elderly patients (HR 0.60, 95%CI 0.42-0.83, P = 0.003). Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%CI 0.47-0.97, P = 0.033), but not in stage I patients or in stage II patients (HR 0.52, 95%CI 0.21-1.30 P = 0.161). Compared to adjuvant chemotherapy without platinum, no significant survival benefits were observed with platinum-containing chemotherapy (HR 0.84, 95%CI 0.49-1.45, P = 0.530). Besides adjuvant chemotherapy, other independent prognostic factors of survival included tumor location, tumor size, histologic grade, depth of tumor invasion, and lymph node status. CONCLUSIONS: This study demonstrated the survival benefits of adjuvant fluoropyrimidine-based chemotherapy among the elderly patients with non-metastatic gastric cancer after D2 gastrectomy. However, due to the limitations of this study, further well-designed prospective studies with large populations are needed to confirm these findings and identify the patients that can tolerate and benefit from adjuvant chemotherapy. |
first_indexed | 2024-12-21T09:32:04Z |
format | Article |
id | doaj.art-f666450f37bc4cfeb254894f7d6a315d |
institution | Directory Open Access Journal |
issn | 1932-6203 |
language | English |
last_indexed | 2024-12-21T09:32:04Z |
publishDate | 2013-01-01 |
publisher | Public Library of Science (PLoS) |
record_format | Article |
series | PLoS ONE |
spelling | doaj.art-f666450f37bc4cfeb254894f7d6a315d2022-12-21T19:08:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0181e5314910.1371/journal.pone.0053149Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy.Ying JinMiao-zhen QiuDe-shen WangDong-sheng ZhangChao RenLong BaiHui-yan LuoZhi-qiang WangFeng-hua WangYu-hong LiRui-hua XuBACKGROUND: A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival. METHODS: We retrospectively reviewed 360 patients who had undergone D2 gastrectomy, aged 65 years or older, with non-metastatic gastric cancer in a single institution. We analyzed the predictors and survival benefits of adjuvant chemotherapy use in the elderly. Further, we analyzed the survival benefits of adjuvant chemotherapy by dividing the patients into groups according to disease stages and chemotherapeutic regimens. RESULTS: Among the 360 patients, only 34.7% of patients received adjuvant chemotherapy. Age, tumor location, lymph node involvement and tumor invasion were associated with the receipt of adjuvant chemotherapy. Adjuvant chemotherapy improved the overall survival for non-metastatic elderly patients (HR 0.60, 95%CI 0.42-0.83, P = 0.003). Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%CI 0.47-0.97, P = 0.033), but not in stage I patients or in stage II patients (HR 0.52, 95%CI 0.21-1.30 P = 0.161). Compared to adjuvant chemotherapy without platinum, no significant survival benefits were observed with platinum-containing chemotherapy (HR 0.84, 95%CI 0.49-1.45, P = 0.530). Besides adjuvant chemotherapy, other independent prognostic factors of survival included tumor location, tumor size, histologic grade, depth of tumor invasion, and lymph node status. CONCLUSIONS: This study demonstrated the survival benefits of adjuvant fluoropyrimidine-based chemotherapy among the elderly patients with non-metastatic gastric cancer after D2 gastrectomy. However, due to the limitations of this study, further well-designed prospective studies with large populations are needed to confirm these findings and identify the patients that can tolerate and benefit from adjuvant chemotherapy.http://europepmc.org/articles/PMC3554736?pdf=render |
spellingShingle | Ying Jin Miao-zhen Qiu De-shen Wang Dong-sheng Zhang Chao Ren Long Bai Hui-yan Luo Zhi-qiang Wang Feng-hua Wang Yu-hong Li Rui-hua Xu Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. PLoS ONE |
title | Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. |
title_full | Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. |
title_fullStr | Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. |
title_full_unstemmed | Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. |
title_short | Adjuvant chemotherapy for elderly patients with gastric cancer after D2 gastrectomy. |
title_sort | adjuvant chemotherapy for elderly patients with gastric cancer after d2 gastrectomy |
url | http://europepmc.org/articles/PMC3554736?pdf=render |
work_keys_str_mv | AT yingjin adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT miaozhenqiu adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT deshenwang adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT dongshengzhang adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT chaoren adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT longbai adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT huiyanluo adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT zhiqiangwang adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT fenghuawang adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT yuhongli adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy AT ruihuaxu adjuvantchemotherapyforelderlypatientswithgastriccancerafterd2gastrectomy |