J Gastric Cancer.  2020 Jun;20(2):152-164. 10.5230/jgc.2020.20.e13.

Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study

  • 1Department of Surgery, Korea University College of Medicine, Seoul, Korea
  • 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
  • 4Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
  • 5Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
  • 7Department of Surgery, Ajou University School of Medicine, Suwon, Korea
  • 8Department of Surgery, Dankook University Hospital, Cheonan, Korea
  • 9Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 10Department of Surgery, Korea Cancer Center Hospital, Seoul, Korea
  • 11Department of Surgery, Konyang University Hospital, Daejeon, Korea
  • 12Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
  • 13Department of Surgery, Kosin University College of Medicine, Busan, Korea
  • 14Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
  • 15Department of Surgery, Jeju National University Hospital, Jeju, Korea
  • 16Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 17Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
  • 18Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
  • 19Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea
  • 20Department of Surgery, Daegu Catholic University College of Medicine, Daegu, Korea
  • 21Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
  • 22Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
  • 23Department of Surgery, Eulji University Hospital, Daejeon, Korea
  • 24Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea


To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC).
Materials and Methods
This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively.
The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693–4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664–1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595–85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502–5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618–3.028; P<0.001) were determined as independent prognostic factors for DFS.
S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.


Gastric cancer; Adjuvant chemotherapy; Disease-free survival
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