Comparison of Adjuvant Capecitabine Plus Oxaliplatin (CAPOX) Versus S-1 After Gastrectomy: a Population-based Cohort Study Using a Nationwide Claims Database

Overview

Journal Sci Rep

Specialty Science

Date 2023 Oct 11

PMID 37821636

Authors

Chi Hoon Maeng

Hoseob Kim

Mina Kim

Affiliations

Soon will be listed here.

Abstract

Although both capecitabine plus oxaliplatin (CAPOX) and S-1 are accepted as adjuvant chemotherapy following gastrectomy for gastric cancer, the better option between the two is still controversial. We conducted a retrospective nationwide cohort study using data from the National Health Insurance Service of Korea. We included patients who underwent gastrectomy for a primary diagnosis of gastric cancer between January 1, 2013, and December 31, 2018. The study compared the survival outcomes of patients who received postoperative chemotherapy based on S-1 (Arm S) vs. CAPOX (Arm C), as well as other relevant clinical variables such as comorbidity and completion of planned treatment. A total of 6602 patients were included in the analysis, with 4199 in Arm S and 2403 in Arm C. After propensity score matching, the final study population consisted of 2067 patients in each arm. Arm C showed statistically inferior 5-year overall survival (OS) and disease-free survival (DFS) rates compared to Arm S (84.0% vs. 90.0%; p < 0.0001; and 78.4% vs. 86.1%; p < 0.0001). Age (65 ≥ vs. < 65) and the incomplete planned treatment also had a significant negative effect on both OS and DFS. In the multivariable analysis, Arm C still showed worse OS (hazard ratio [HR], 1.609; 95% confidence intervals [CI], 1.339-1.934; p < 0.0001) and DFS (HR, 1.552; 95% CI 1.333-1.807; p < 0.0001) than Arm S. Both S-1 and CAPOX showed excellent efficacy, but this nationwide cohort study suggests that S-1 may be a better option in certain clinical situations.

References

Jung K, Won Y, Hong S, Kong H, Im J, Seo H . Prediction of Cancer Incidence and Mortality in Korea, 2021. Cancer Res Treat. 2021; 53(2):316-322. PMC: 8053854. DOI: 10.4143/crt.2021.290. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Al-Batran S, Homann N, Pauligk C, Goetze T, Meiler J, Kasper S . Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma.... Lancet. 2019; 393(10184):1948-1957. DOI: 10.1016/S0140-6736(18)32557-1. View

Kang Y, Yook J, Park Y, Lee J, Kim Y, Kim J . PRODIGY: A Phase III Study of Neoadjuvant Docetaxel, Oxaliplatin, and S-1 Plus Surgery and Adjuvant S-1 Versus Surgery and Adjuvant S-1 for Resectable Advanced Gastric Cancer. J Clin Oncol. 2021; 39(26):2903-2913. PMC: 8425847. DOI: 10.1200/JCO.20.02914. View

Cho J, Lim J, Cho J . Comparison of capecitabine and oxaliplatin with S-1 as adjuvant chemotherapy in stage III gastric cancer after D2 gastrectomy. PLoS One. 2017; 12(10):e0186362. PMC: 5645114. DOI: 10.1371/journal.pone.0186362. View

Yoshida K, Kodera Y, Kochi M, Ichikawa W, Kakeji Y, Sano T . Addition of Docetaxel to Oral Fluoropyrimidine Improves Efficacy in Patients With Stage III Gastric Cancer: Interim Analysis of JACCRO GC-07, a Randomized Controlled Trial. J Clin Oncol. 2019; 37(15):1296-1304. PMC: 6524985. DOI: 10.1200/JCO.18.01138. View

Lee C, Yoo M, Son Y, Oh S, Kim J, Kim H . Long-term Efficacy of S-1 Monotherapy or Capecitabine Plus Oxaliplatin as Adjuvant Chemotherapy for Patients with Stage II or III Gastric Cancer after Curative Gastrectomy: a Propensity Score-Matched Multicenter Cohort Study. J Gastric Cancer. 2020; 20(2):152-164. PMC: 7311213. DOI: 10.5230/jgc.2020.20.e13. View

Oh S, An J, Choi M, Lee J, Sohn T, Bae J . Comparison of Long-Term Efficacy in S-1 and Capecitabine With Oxaliplatin as Adjuvant Chemotherapy for Patients With Gastric Cancer After Curative Surgery: A Retrospective, Single-Center Observational Study. Technol Cancer Res Treat. 2021; 20:15330338211039679. PMC: 8493307. DOI: 10.1177/15330338211039679. View

Kim I, Park S, Lee C, Kim M, Kwon I, Min J . Efficacy of Adjuvant S-1 Versus XELOX Chemotherapy for Patients with Gastric Cancer After D2 Lymph Node Dissection: A Retrospective, Multi-Center Observational Study. Ann Surg Oncol. 2018; 25(5):1176-1183. DOI: 10.1245/s10434-018-6375-z. View

10.

Hsieh M, Wang S, Wei C, Chen C, Chen Y, Pei S . S1 versus Doublet Regimens as Adjuvant Chemotherapy in Patients with Advanced Gastric Cancer after Radical Surgery with D2 Dissection-A Propensity Score Matching Analysis. Cancers (Basel). 2020; 12(9). PMC: 7565691. DOI: 10.3390/cancers12092384. View

11.

Shin K, Park S, Lee J, Park C, Song K, Lee H . Efficacy of capecitabine and oxaliplatin versus S-1 as adjuvant chemotherapy in gastric cancer after D2 lymph node dissection according to lymph node ratio and N stage. BMC Cancer. 2019; 19(1):1232. PMC: 6921502. DOI: 10.1186/s12885-019-6433-3. View

12.

Jeong S, Kim R, Oh S, An J, Seo K, Min J . Efficacy of S-1 or Capecitabine Plus Oxaliplatin Adjuvant Chemotherapy for Stage II or III Gastric Cancer after Curative Gastrectomy: A Systematic Review and Meta-Analysis. Cancers (Basel). 2022; 14(16). PMC: 9406447. DOI: 10.3390/cancers14163940. View

13.

Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A . Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007; 357(18):1810-20. DOI: 10.1056/NEJMoa072252. View

14.

Bang Y, Kim Y, Yang H, Chung H, Park Y, Lee K . Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012; 379(9813):315-21. DOI: 10.1016/S0140-6736(11)61873-4. View

15.

Kim T, Kim I, Kang S, Choi M, Kim B, Eom B . Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer. 2023; 23(1):3-106. PMC: 9911619. DOI: 10.5230/jgc.2023.23.e11. View

16.

Park S, Lim D, Sohn T, Lee J, Zang D, Kim S . A randomized phase III trial comparing adjuvant single-agent S1, S-1 with oxaliplatin, and postoperative chemoradiation with S-1 and oxaliplatin in patients with node-positive gastric cancer after D2 resection: the ARTIST 2 trial. Ann Oncol. 2020; 32(3):368-374. DOI: 10.1016/j.annonc.2020.11.017. View

17.

Noh S, Park S, Yang H, Chung H, Chung I, Kim S . Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial. Lancet Oncol. 2014; 15(12):1389-96. DOI: 10.1016/S1470-2045(14)70473-5. View

18.

Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T . 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(33):4387-93. DOI: 10.1200/JCO.2011.36.5908. View

19.

Shin C, Lee W, Hong S, Chang Y . Characteristics of gastric cancer recurrence five or more years after curative gastrectomy. Chin J Cancer Res. 2016; 28(5):503-510. PMC: 5101224. DOI: 10.21147/j.issn.1000-9604.2016.05.05. View

20.

Lee J, Lee J, Kim J, Na H, Ahn J, Jung K . Predictive Role of Endoscopic Surveillance after Total Gastrectomy with R0 Resection for Gastric Cancer. J Korean Med Sci. 2021; 36(14):e88. PMC: 8042482. DOI: 10.3346/jkms.2021.36.e88. View