J Gastric Cancer.  2018 Sep;18(3):264-273. 10.5230/jgc.2018.18.e29.

Who Can Perform Adjuvant Chemotherapy Treatment for Gastric Cancer? A Multicenter Retrospective Overview of the Current Status in Korea

• Min JS
• Lee CM
• Choi SI
• Seo KW
• Park DJ
• Baik YH
• Son MW
• Choi WH
• Kim S
• Pak KH
• Kim MG
• Park JM
• Jeong SH
• Lee MS
• Park S

• KMID: 2420786
• DOI: http://doi.org/10.5230/jgc.2018.18.e29

Abstract

PURPOSE
To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers.
MATERIALS AND METHODS
We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists.
RESULTS
Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After performing PSM, surgical oncologists (82.74%) completed AC as planned more often than medical oncologists (75.9%), with statistical significance (P=0.036). No difference in the 3-year DFS rates of stage II (P=0.567) or stage III (P=0.545) gastric cancer was found between the medical and surgical oncologist groups.
CONCLUSIONS
S-1 monotherapy and XELOX are a main stay of AC, regardless of whether the prescribing physician is a medical or surgical oncologist. The better compliance with AC by surgical oncologists is a valid reason to advocate that surgical oncologists perform the treatment of AC for stage II or III gastric cancers.

Keyword

Gastric cancer; Adjuvant chemotherapy

MeSH Terms

Capecitabine
Chemotherapy, Adjuvant*
Compliance
Disease-Free Survival
Hospitals, University
Humans
Korea*
Logistic Models
Observational Study
Propensity Score
Referral and Consultation
Retrospective Studies*
Selection Bias
Stomach Neoplasms*
Capecitabine

Figure

• 

  Fig. 1 Regimens of adjuvant chemotherapy for stage II and III gastric cancer, according to the prescribing department.S-1 = tegafur/gimeracil/oteracil; FOXFOX = 5-fluorouracil, folinic acid, and oxaliplatin; UFT = tegafur/uracil; XP = capecitabine and cisplatin; XELOX = capecitabine and oxaliplatin; FP = 5-fluorouracil and cisplatin; SP = S-1 and cisplatin.

• 

  Fig. 2 Flowchart of PSM.PSM = propensity score matching; ASA = American Society of Anesthesiologists; T = tumor; N = node; AJCC = American Joint Committee on Cancer; S-1 = tegafur/gimeracil/oteracil; XELOX, capecitabine and oxaliplatin.

• 

  Fig. 3 DFS in patients with gastric cancer, analyzed by department administering adjuvant chemotherapy.DFS = disease-free survival.

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