The Clinical And Pathological Features Of Adjuvant Chemotherapy Gemcitabine Analysis II-III Gastric Cancer Postoperative Oxaliplatin Combined With Capecitabine

ObjectiveTo investigate the efficacy and toxicity of adjuvant chemotherapy of oxaliplatin pluscapecitabine with capecitabine extendedtherapy in stage II-IIIgastric cancer patients.To explore the expression of TS,ERCC1,CDX-2,HER2and Ki-67index in gastric cancer and to explore their correlationwith prognosis.MethodsForty-four adult patients with stage II-III gastric cancer who underwent D1or D2gastrectomy from Mar2005to Aug2011in Peking Union Medical College Hospital were enrolled in the study. The patients were planned to receive six to eight cycles of standard XELOX regimen, followed by capecitabine monotherapy. XELOX regimen consisted of oxaliplatin130mg/m2on Dayl, capecitabine1000mg/m2bid from Day1to Day14, repeated every3weeks. The dosage of capecitabine in monotherapy was as same as it in XELOX regimen. The efficacy was assessed in every three cycles and the toxicity was recorded during follow-up. The primary end point was DFS.And IHC results of TS,ERCC1,CDX-2,HER2and Ki-67index were analyzed.Then the correlation between their expression,clinicopathologic characteristics and survival was analyzed by SPSS17.0software.ResultsIn forty-four assessable patients,30males (68.2%) and14females(31.8%); medianage was62years old(34-79); TNM(AJCC7.0) stageII6cases(13.6%) and stage Ⅲ38cases (86.4%); twelve (27.3%)patientsreceivedcapecitabineextended therapy;the media follow-up was26.6months(7.2-83.9).Until March15th2012,there were16cases(36.4%) progressed,9cases(20.5%) died.Fifteen patients (34.1%) had D1resection and another twenty-nine patients(65.9%) had D2resection. The median DFS was30.0months in D1group and56.0months in D2group(P>0.05).Three-year survival rate of D1and D2group was60.6%、61.5%respectively. Subgroup analysis of stage III showed that the median DFS in D2group is significantly longer than in D1group(56.0m vs.27.5m, P=0.032).Twelve patients (27.3%) received Capecitabine extendedtherapy. There was no significant difference in median DFS between extended group and non-extended group(53.0m vs.31.5m,P>0.05).Three-year DFS rate of them was45.7%>42.5%respectively.Univariate analysis showed that overallDFSinregionallymph node metastasisN0-2group was significantlylonger thanofN3(56.0m vs.25.0m, P=0.015), regardlessof other clinicopathological factors. The Cox Regression analysis showed thatregionallymph node metastasis was anindependent prognosticfactor of DFS.In adjuvant chemotherapy phase, the descending order ofincidenceoftoxicity were nausing and vomitting,neutropenia,thrombocytopenia, decreased appetite,peripheral neurotoxicity,diahhrea,hand-foot syndrome and constipation.Inadjuvant phase Grade3/4adverse events were occurred in12/40patients (30%), while in extended phase there was only1/9patients(11.1%) reported Grade3hand-foot syndrome.The positive expression rates of TS,ERCC1,CDX-2and HER2were25.0%,100.0%,78.6%and21.4%respectively.The proportion of Ki-67index≥50%was42.9%. Positive Ki-67index (≥20%)were more commoninmale than female(P=0.031).High expression of ERCC1were more common in reginal lymph node metastasis group.Univariate analysis showed thatmedian DFS was significantly longer in CDX-2positive group(P=0.014). Cox Regression analysisshowedCDX-2was anindependent prognostic factor for DFS(RR0.207,95%CI:0.053-0.816).ConclusionsThe patients with operable gastric cancer should be performed D2resection. Capecitabine extendedchemotherapy was well tolerated, but did not show survival advantage in this small-scale study. We need further prospective study to investigate the value of capecitabine extended therapy. CDX-2may be an independentprognostic factorfordisease-free survival.