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Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, Nashimoto A, Fujii M, Nakajima T, Ohashi Y. Five-Year Outcomes of a Randomized Phase III Trial Comparing Adjuvant Chemotherapy With S-1 Versus Surgery Alone in Stage II or III Gastric Cancer. J Clin Oncol 2011; 29:4387-93. [PMID: 22010012 DOI: 10.1200/jco.2011.36.5908] [Citation(s) in RCA: 1014] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose The first planned interim analysis (median follow-up, 3 years) of the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer confirmed that the oral fluoropyrimidine derivative S-1 significantly improved overall survival, the primary end point. The results were therefore opened at the recommendation of an independent data and safety monitoring committee. We report 5-year follow-up data on patients enrolled onto the ACTS-GC study. Patients and Methods Patients with histologically confirmed stage II or III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were randomly assigned to receive S-1 after surgery or surgery only. S-1 (80 to 120 mg per day) was given for 4 weeks, followed by 2 weeks of rest. This 6-week cycle was repeated for 1 year. The primary end point was overall survival, and the secondary end points were relapse-free survival and safety. Results The overall survival rate at 5 years was 71.7% in the S-1 group and 61.1% in the surgery-only group (hazard ratio [HR], 0.669; 95% CI, 0.540 to 0.828). The relapse-free survival rate at 5 years was 65.4% in the S-1 group and 53.1% in the surgery-only group (HR, 0.653; 95% CI, 0.537 to 0.793). Subgroup analyses according to principal demographic factors such as sex, age, disease stage, and histologic type showed no interaction between treatment and any characteristic. Conclusion On the basis of 5-year follow-up data, postoperative adjuvant therapy with S-1 was confirmed to improve overall survival and relapse-free survival in patients with stage II or III gastric cancer who had undergone D2 gastrectomy.
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Affiliation(s)
- Mitsuru Sasako
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Shinichi Sakuramoto
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Hitoshi Katai
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Taira Kinoshita
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Hiroshi Furukawa
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Toshiharu Yamaguchi
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Atsushi Nashimoto
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Masashi Fujii
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Toshifusa Nakajima
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
| | - Yasuo Ohashi
- Mitsuru Sasako, Hyogo College of Medicine, Nishinomiya; Shinichi Sakuramoto, Kitasato University School of Medicine, Sagamihara; Hitoshi Katai, National Cancer Center Hospital; Toshiharu Yamaguchi and Toshifusa Nakajima, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Masashi Fujii, Nihon University School of Medicine; Yasuo Ohashi, School of Public Health, The University of Tokyo, Tokyo; Taira Kinoshita, National Cancer Center Hospital East, Kashiwa; Hiroshi Furukawa, Sakai Municipal
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