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Gastric Cancer

, Volume 21, Issue 5, pp 792–801 | Cite as

First-line chemotherapy with S-1 alone or S-1 plus cisplatin for elderly patients with advanced gastric cancer: a multicenter propensity score matched study

  • Akitaka Makiyama
  • Kenji Kunieda
  • Masaaki Noguchi
  • Takeshi Kajiwara
  • Takao Tamura
  • Koji Takeda
  • Junko Sugiyama
  • Keiko Minashi
  • Toshikazu Moriwaki
  • Naotoshi Sugimoto
  • Michitaka Nagase
  • Yuji Negoro
  • Takashi Tsuda
  • Hideki Shimodaira
  • Naohiro Okano
  • Akihito Tsuji
  • Daisuke Sakai
  • Kazuhiro Yanagihara
  • Shinya Ueda
  • Shingo Tamura
  • Satoshi Otsu
  • Takuya Honda
  • Yuzo Matsushita
  • Tatsuya Okuno
  • Tomomi Kashiwada
  • Akira Nozaki
  • Masahide Ebi
  • Hiroyuki Okuda
  • Mototsugu Shimokawa
  • Shuichi Hironaka
  • Ichinosuke Hyodo
  • Eishi Baba
  • Narikazu Boku
  • Kei Muro
  • Taito Esaki
Original Article
  • 406 Downloads

Abstract

Background

Fluoropyrimidine and platinum combination is the standard treatment for advanced or recurrent gastric cancer (AGC). However, fluoropyrimidine monotherapy is commonly used for elderly patients with AGC because of its good tolerability.

Methods

In this multicenter retrospective study, we collected clinical data of AGC patients aged 70 years or older, treated with S-1 alone or S-1 plus cisplatin (SP) as the first-line treatment between January 2009 and December 2011. Propensity score matched cohorts (PSMC) were used for reducing the confounding effects to compare efficacy and safety between the two treatment groups. Cox regression analysis was performed to clarify the prognostic factors.

Results

PSMC (n = 109 in each group) were selected from among 444 eligible patients (S-1 group, 210; SP group, 234); the S-1 group included more patients deemed unfit for intensive chemotherapy than the SP group (e.g., higher age, poorer PS, poor renal function). In the PSMC, patients’ characteristics were comparable between groups, except the male ratio (S-1 group, 64.2%; SP group, 77.1%; p = 0.04). No significant differences were observed in either overall survival [hazard ratio (HR) 0.93, p = 0.63] or progression-free survival (HR 1.09, p = 0.61). Severe adverse events (AEs) and hospitalization due to AEs were more frequent in the SP group than in the S-1 group (p < 0.001 each).

Conclusion

Our findings do not support the survival benefit of SP over S-1 in elderly patients with AGC. We are now conducting a prospective comparative study to optimize treatment strategy and explore applicability of the geriatric assessment for these patients.

Keywords

Elderly patients Gastric cancer S-1 Cisplatin Propensity score matching method (3-5 words) 

Notes

Acknowledgements

We thank all patients included in this study, the medical staff who contributed to the treatment of patients from each institution, and all the investigators in the West Japan Oncology Group (WJOG).

Compliance with ethical standards

Conflicts of interest

No potential conflicts of interest to disclose.

Research involving human participants

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Supplementary material

10120_2018_797_MOESM1_ESM.docx (41 kb)
Supplementary material 1 (DOCX 41 kb)

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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Akitaka Makiyama
    • 1
  • Kenji Kunieda
    • 2
  • Masaaki Noguchi
    • 3
  • Takeshi Kajiwara
    • 4
  • Takao Tamura
    • 5
  • Koji Takeda
    • 6
  • Junko Sugiyama
    • 7
  • Keiko Minashi
    • 8
  • Toshikazu Moriwaki
    • 9
  • Naotoshi Sugimoto
    • 10
  • Michitaka Nagase
    • 11
  • Yuji Negoro
    • 12
  • Takashi Tsuda
    • 13
  • Hideki Shimodaira
    • 14
  • Naohiro Okano
    • 15
  • Akihito Tsuji
    • 16
  • Daisuke Sakai
    • 17
  • Kazuhiro Yanagihara
    • 18
  • Shinya Ueda
    • 19
  • Shingo Tamura
    • 20
  • Satoshi Otsu
    • 21
  • Takuya Honda
    • 22
  • Yuzo Matsushita
    • 23
  • Tatsuya Okuno
    • 24
  • Tomomi Kashiwada
    • 25
  • Akira Nozaki
    • 26
  • Masahide Ebi
    • 27
  • Hiroyuki Okuda
    • 28
  • Mototsugu Shimokawa
    • 29
  • Shuichi Hironaka
    • 8
  • Ichinosuke Hyodo
    • 9
  • Eishi Baba
    • 30
  • Narikazu Boku
    • 31
  • Kei Muro
    • 32
  • Taito Esaki
    • 33
  1. 1.Department of Hematology/Oncology, Japan Community Healthcare OrganizationKyushu HospitalKitakyushuJapan
  2. 2.Department of GI OncologyShizuoka Cancer CenterShizuokaJapan
  3. 3.Department of Gastrointestinal OncologyNational Cancer Center Hospital EastKashiwaJapan
  4. 4.Department of Gastrointestinal Medical OncologyNational Hospital Organization Shikoku Cancer CenterMatsuyamaJapan
  5. 5.Department of Medical OncologyKindai University Faculty of MedicineOsaka-SayamaJapan
  6. 6.Department of Medical OncologyOsaka City General HospitalOsakaJapan
  7. 7.Department of Medical OncologyTonan HospitalSapporoJapan
  8. 8.Clinical Trial Promotion DepartmentChiba Cancer CenterChibaJapan
  9. 9.Division of Gastroenterology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  10. 10.Department of Medical OncologyOsaka International Cancer InstituteOsakaJapan
  11. 11.Department of Clinical OncologyNagoya Red-Cross Daiichi HospitalNagoyaJapan
  12. 12.Division of Gastroenterological MedicineKochi Health Sciences CenterKochiJapan
  13. 13.Department of Clinical OncologySt. Marianna University School of MedicineKawasakiJapan
  14. 14.Department of Clinical OncologyTohoku University HospitalSendaiJapan
  15. 15.Department of Medical OncologyKyorin University Faculty of MedicineTokyoJapan
  16. 16.Department of Medical OncologyKagawa University HospitalKagawaJapan
  17. 17.Department of Frontier Science for Cancer and ChemotherapyOsaka University Graduate School of MedicineOsakaJapan
  18. 18.Department of Medical OncologyKansai Electric Power HospitalOsakaJapan
  19. 19.Department of Medical OncologyNara Hospital Kindai University School of MedicineIkomaJapan
  20. 20.Department of Internal MedicineKyushu University Beppu HospitalBeppuJapan
  21. 21.Department of Medical Oncology and HematologyOita University Faculty of MedicineYufuJapan
  22. 22.Department of Clinical Oncology CenterNagasaki University HospitalNagasakiJapan
  23. 23.Department of Medical OncologyHamanomachi HospitalFukuokaJapan
  24. 24.Division of Gastroenterology, Department of Internal Medicine Graduate School of MedicineKobe UniversityKobeJapan
  25. 25.Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of MedicineSaga UniversitySagaJapan
  26. 26.Department of Clinical OncologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
  27. 27.Department of GastroenterologyAichi Medical University School of MedicineNagakuteJapan
  28. 28.Department of Medical OncologyKeiyukai Sapporo HospitalSapporoJapan
  29. 29.Cancer Biostatistics Laboratory, Clinical Research InstituteNational Hospital Organization Kyushu Cancer CenterFukuokaJapan
  30. 30.Department of Comprehensive Clinical Oncology, Faculty of Medical SciencesKyushu UniversityFukuokaJapan
  31. 31.Division of Gastrointestinal Medical OncologyNational Cancer Center HospitalTokyoJapan
  32. 32.Department of Clinical Oncology and Outpatient Treatment CenterAichi Cancer Center HospitalNagoyaJapan
  33. 33.Department of Gastrointestinal and Medical OncologyNational Kyushu Cancer CenterFukuokaJapan

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