Long-term outcomes of preoperative docetaxel with cisplatin plus S-1 therapy for gastric cancer with extensive nodal met
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ORIGINAL ARTICLE
Long‑term outcomes of preoperative docetaxel with cisplatin plus S‑1 therapy for gastric cancer with extensive nodal metastasis (JCOG1002) Daisuke Takahari1 · Seiji Ito2 · Junki Mizusawa3 · Hiroshi Katayama3 · Masanori Terashima4 · Mitsuru Sasako5 · Shinji Morita6 · Takashi Nomura7 · Makoto Yamada8 · Yoshiyuki Fujiwara9 · Yutaka Kimura10 · Atsuki Ikeda11 · Yoshio Kadokawa12 · Takeshi Sano13 on behalf of the Stomach Cancer Study Group of the Japan Clinical Oncology Group Received: 10 June 2019 / Accepted: 2 September 2019 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019
Abstract Background Preoperative chemotherapy with cisplatin plus S-1 (CS) followed by gastrectomy with D2 plus para-aortic lymph node (PAN) dissection is regarded as a standard treatment in Japan for advanced gastric cancer with bulky lymph node (BN) and/or PAN metastasis. In the JCOG1002, we added docetaxel to CS (DCS) to further improve long-term outcomes. However, the primary endpoint, clinical response rate (RR), did not reach the expected level (Ito et al. in Gastric Cancer 20:322–31, 2017). Herein, we report our long-term survival results. Methods Patients with BN and/or PAN metastasis received 2 or 3 cycles of DCS therapy (docetaxel at 40 mg/m2 and cisplatin at 60 mg/m2 on day 1 and S-1 at 80 mg/m2 per day for 2 weeks, followed by a 2-week rest) followed by gastrectomy with D2 plus PAN dissection and postoperative S-1 for 1 year. Results Between July 2011 and May 2013, 53 patients were enrolled. Clinically, 17.0% had both PAN and BN metastasis, and the rest had either PAN (26.4%) or BN (56.6%) metastasis. Among all eligible patients, the 5-year overall survival was 54.9% (95% confidence interval 40.3–67.3%) at the last follow-up in May 2018. Among 44 eligible patients with R0 resection, the 5-year relapse-free survival was 47.7% (95% confidence interval 32.5–61.5%). Conclusions Adding docetaxel to CS in preoperative chemotherapy for extensive nodal metastasis improved neither shortterm outcomes nor long-term survival. Preoperative chemotherapy with CS followed by D2 + PAN dissection and postoperative S-1 remains the standard of care for patients with extensive nodal metastasis. Keywords Gastric cancer · Extensive lymph node metastasis · Preoperative chemotherapy · DCS
* Daisuke Takahari [email protected] 1
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Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
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Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3‑8‑31 Ariake, Koto‑ku, Tokyo 135‑8550, Japan
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Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Department of Surgery, Sakai City Medical Center, Sakai, Japan
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Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hosp
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