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...

Full description

Bibliographic Details
Main Authors: 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
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