The Efficacy of Adjuvant FOLFOX6 for Patients With Gastric Cancer after D2 Lymphadenectomy

Autor: Dong Sheng Zhang, Rui-Hua Xu, Ming Ming He, Feng Wang, You Qing Zhan, Yu Hong Li, Xu Long Yang, Zi Xian Wang, Zhiwei Zhou
Rok vydání: 2016
Předmět:
Male
Oncology
Time Factors
Organoplatinum Compounds
Leucovorin
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
Hazard ratio
General Medicine
Middle Aged
Prognosis
Survival Rate
Chemotherapy
Adjuvant
Lymphatic Metastasis
030220 oncology & carcinogenesis
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Female
030211 gastroenterology & hepatology
Fluorouracil
Research Article
medicine.drug
China
medicine.medical_specialty
Observational Study
Adenocarcinoma
03 medical and health sciences
Folinic acid
Gastrectomy
Stomach Neoplasms
Internal medicine
medicine
Humans
Propensity Score
Survival rate
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Proportional hazards model
business.industry
Cancer
Nomogram
medicine.disease
Oxaliplatin
Surgery
Nomograms
Propensity score matching
Lymph Node Excision
business
Follow-Up Studies
Zdroj: Medicine
ISSN: 0025-7974
DOI: 10.1097/md.0000000000003214
Popis: Supplemental Digital Content is available in the text
Adjuvant 5-fluorouracil, folinic acid, and oxaliplatin (FOLFOX6) are widely used for treating resected gastric cancer in clinics in China, but only few clinical trials have investigated its efficacy. Using propensity score matching, we evaluated the efficacy of adjuvant FOLFOX6 following D2 lymphadenectomy. Patients who received adjuvant FOLFOX6 following D2 lymphadenectomy (FOLFOX6, n = 113) or D2 lymphadenectomy only (surgery-only, n = 512) between 1998 and 2007 at our center were propensity score-matched; we identified a balanced 1:2 cohort, with 96 patients in the FOLFOX6 group and 192 patients in the surgery-only group. The overall survival (OS) was estimated using the Kaplan–Meier method; factors affecting survival were identified by Cox regression models. A nomogram incorporating independent prognosticators was constructed for predicting the 3-, 5-, and 7-year OS, and bootstrap validation was performed. The median follow-up was 9.3 years, and the 7-year OS was 52.1% in the FOLFOX6 group and 43.8% in the surgery-only group (P = 0.04), with an adjusted hazard ratio of 0.69 (95% confidence interval = 0.49–0.98). A prognostic nomogram was generated with the identified significant prognosticators (adjuvant FOLFOX6, number of total harvested nodes, the interaction effect between these two variables, tumor size, T and N stage). Internal validation of the nomogram revealed good predictive abilities, with a bootstrap-corrected concordance index of 0.70. Adjuvant FOLFOX6 following D2 lymphadenectomy is associated with survival benefit in resected gastric cancer. Receiving adjuvant FOLFOX6 can be developed into a nomogram with other independent prognosticators to refine OS prediction and estimation of benefit from adjuvant FOLFOX6 for resected gastric cancer.
Databáze: OpenAIRE
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