ABSENCE OF LIVER METASTASIS, LYMPH NODE METASTASIS AND PERITONEAL METASTASIS PREDICT LONGER PROGRESSION FREE SURVIVAL BY S-1 PLUS CISPLATIN TREATMENT IN ADVANCED GASTRIC CANCER

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Abstract

Background

Some reports have shown long-term survival cases in advanced gastric cancer (AGC). In our institute, some patients with AGC have had complete response (CR) with cisplatin plus S1 (SP) treatment, and some of them had been stopped their chemotherapy. The purpose of this study was to evaluate clinicopathological backgrounds of long-term responder and to find out features of cases that can stop their chemotherapy.

Patients and methods

From 2007 to 2009, 142 patients treated with SP as first-line chemotherapy in Cancer Institute Hospital of JFCR. We regarded patients whose progression-free survival (PFS) was above 500 days as long-term responders (group A),and others as control group (group B). We evaluated clinicopathological features of them, and univariate and multivariate analyses were carried out on the baseline factors before starting chemotherapy.

Results

Of 142 patients, 24 patients were categorized group A. Patients characteristics were as follows (group A versus B): median age, 58.2 versus 58.0 (years); gender (male), 62.5% versus 72.9%; ECOG performance status 0, 91.7% versus 80.0%; previous gastrectomy, 75.0% versus 11.0%; histological type (intestinal), 29.2% versus 25.4%; metastatic site (liver 12.5% versus 44.1%, lymph node 20.8% versus 78.0%, peritomeum 4.2% versus 44.9%).Of patients in group A, 16 patients have had CR. Four of them quit SP treatment (median length of treatment was 35.4 month) and only one patient had PD in 2 months after discontinuance of treatment. In univariate analysis, the absence of measurable lesion (P < 0.0001), recent gastrectomy (P < 0.0001), absence of metastatic site of liver (P = 0.004), lymph node (P < 0.0001), peritoneum (P < 0.0001) predicted long-term disease control. Multivariate analysis showed three limiting factor predicted long-term survival; absence of metastatic site of liver (P = 0.004), lymph node (P = 0.001), peritoneum (P < 0.0001). Histological type, ECOG performance status, tumor marker did not show statistical significance.

Conclusion

Absence of liver, lymph node, and peritoneal metastasis predicted longer PFS, and there were tendency that the absence of measurable lesion and recent gastrectomy predict long-term disease control.

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