International Journal of Clinical Oncology

, Volume 24, Issue 10, pp 1190–1196 | Cite as

Late start and insufficient S-1 dose in adjuvant chemotherapy can lead to poor prognosis in stage II/III gastric cancer

  • Kozo Miyatani
  • Hiroaki SaitoEmail author
  • Shota Shimizu
  • Yusuke Kono
  • Yuki Murakami
  • Yuji Shishido
  • Tomoyuki Matsunaga
  • Yoji Fukumoto
  • Yoshiyuki Fujiwara
Original Article



How the interval between surgery and S-1 adjuvant chemotherapy (ACT), and S-1 relative dose intensity (RDI) affect prognosis in patients with stage II/III gastric cancer who undergo gastrectomy with D2 lymph node dissection followed by S-1 ACT is unclear.


We enrolled 95 patients with histopathologically confirmed gastric adenocarcinoma treated with gastrectomy with D2 dissection, followed by S-1 ACT.


Per ROC analysis, we used 32 days as the optimal cut-off interval to divide patients into the delayed group (started ACT ≥ 32 days) and the non-delayed group ( < 32 days). Their 5-year overall survival (OS) rates differed significantly (delayed: 54.2%, non-delayed: 85.4%; P  <  0.0001). Per ROC analysis of patients without recurrence within 1 year post-surgery, patients were divided into the high RDI (RDIHigh; ≥ 64.6%) and low RDI (RDILow; <  64.6%) groups. Their 5-year OS rates differed significantly (RDIHigh: 76.9%, RDILow: 63.7%; P  =  0.012). In multivariate analysis, RDI and interval before starting ACT were independent prognostic indicators. Five- year OS rates by subgroups were RDIHigh/non-delayed: 84.0%, RDIHigh/delayed: 66.8%, RDILow/non-delayed: 100%, and RDILow/delayed: 48.2% (P  < 0.0001).


Early initiation and sufficient RDI for S-1 ACT can improve the prognosis of patients with stage II/III gastric cancer.


Adjuvant chemotherapy Gastric cancer Prognosis Recurrence S-1 



We thank Marla Brunker, from Edanz Group ( for editing a draft of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or with comparable ethical standards.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of Surgery, School of MedicineTottori University Faculty of MedicineYonagoJapan

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