Adjuvant Chemotherapy is an Additional Option for Locally Advanced Gastric Cancer After Radical Gastrectomy with D2 Lymphadenectomy: A Retrospective Control Study

Abstract Background: This study compared the long-term efficacy of different durations of adjuvant chemotherapy for patients with gastric cancer after radical gastrectomy with D2 lymphadenectomy.Methods: We retrospectively identified 428 patients with stage II–III gastric cancer who underwent D2 gastrectomy between 2009 and 2016. Patients were divided into four groups according to the duration of adjuvant chemotherapy, including 0 week (no adjuvant, group A), 20 to 24 weeks (completed 7-8 cycles every 3 weeks or 10-12 cycles every 2 weeks, group B), and 12 to18 weeks (completed 4-6 cycles every 3 weeks or 6-9 cycles every 2 weeks, group C), and less than 12 weeks (received up to 3 cycles every 3 weeks or 5 cycles every 2 weeks, group D). The chemotherapy regimens included SOX, XELOX, and FOLFOX. Five-year overall survival (OS) and disease-free survival (DFS) were analyzed.Results: The five-year DFS rates for groups A, B, C, and D were 50, 68.0, 65.4, and 50.0%, respectively, and the 5-year OS rates were 52.3, 73.7, 72.0, and 53.3%, respectively. DFS and OS were higher in group B than in groups A and D. Similarly, patients in group C were more likely to have better DFS and OS than those in groups A and D. Meanwhile, there were no significant differences in DFS and OS between groups B and C. In multivariate analyses, the number of adjuvant chemotherapy cycles was a significant prognostic factor. Conclusions: To reduce toxicity and maintain efficacy, fluorouracil and oxaliplatin doublet adjuvant chemotherapy administered for 4–6 cycles every 3 weeks or 6–9 cycles every 2 weeks might be a favorable option for patients with stage II–III gastric cancer after D2 gastrectomy. Prospective multicenter clinical trials with large sample sizes are necessary to verify these findings.