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Proposal of a Scoring Scale to Estimate Risk of the Discontinuation of S-1 Adjuvant Monotherapy in Patients with Stage II to III Gastric Cancer: A Multi-Institutional Dataset Analysis

  • Akimitsu Iizuka
  • Mitsuro KandaEmail author
  • Seiji Ito
  • Yoshinari Mochizuki
  • Hitoshi Teramoto
  • Kiyoshi Ishigure
  • Toshifumi Murai
  • Takahiro Asada
  • Akiharu Ishiyama
  • Hidenobu Matsushita
  • Chie Tanaka
  • Daisuke Kobayashi
  • Michitaka Fujiwara
  • Kenta Murotani
  • Yasuhiro Kodera
Original Scientific Report
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Abstract

Background

Discontinuation of postoperative S-1 adjuvant monotherapy is a frequent problem in the management of patients with gastric cancer.

Methods

A total of 355 stage II/III gastric cancer patients who underwent gastrectomy and adjuvant S-1 were retrospectively analyzed using a multicenter dataset. We randomly assigned patients into either discovery or validation cohort in a 2:1 ratio. In the discovery cohort, 29 parameters were assessed as candidate factors to predict discontinuation of S-1 adjuvant within 6 months. A scoring system was designed using independent risk factors identified by the multivariate analysis. Reproducibility was tested in the validation cohort.

Results

Overall, 92 patients (25.9%) discontinued the treatment within 6 months because of adverse effects. Age, preoperative urea nitrogen (UN) and the preoperative albumin-to-bilirubin index (ALBI) showed the highest area under the curve (AUC) for the discontinuation of S-1 adjuvant within 6 months in each category: body status, blood tests and indices. In the multivariate analysis, age ≥ 64 years, preoperative UN ≥ 15.2 mg/dl and preoperative ALBI ≥ −0.265 were identified as independent risk factors. A scoring scale consisting of these three factors was developed for the prediction of drug discontinuation and demonstrated a greater AUC (0.728) than that of each of the three constituents. The time to treatment discontinuation decreased incrementally as the risk score increased. The reproducible findings were confirmed in the validation cohort.

Conclusions

We identified risk factors and developed a scoring scale to predict S-1 adjuvant monotherapy discontinuation in patients with stage II/III gastric cancer.

Notes

Compliance with ethical standards

Conflict of interest

The authors do not have any commercial interest or sources of financial or material support to report.

Human and animal rights

This study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards and with the ethical standards of the institutional committee

Supplementary material

268_2019_4942_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Akimitsu Iizuka
    • 1
  • Mitsuro Kanda
    • 2
    Email author
  • Seiji Ito
    • 3
  • Yoshinari Mochizuki
    • 4
  • Hitoshi Teramoto
    • 5
  • Kiyoshi Ishigure
    • 6
  • Toshifumi Murai
    • 7
  • Takahiro Asada
    • 8
  • Akiharu Ishiyama
    • 1
  • Hidenobu Matsushita
    • 9
  • Chie Tanaka
    • 2
  • Daisuke Kobayashi
    • 2
  • Michitaka Fujiwara
    • 2
  • Kenta Murotani
    • 10
  • Yasuhiro Kodera
    • 2
  1. 1.Department of SurgeryOkazaki City HospitalOkazakiJapan
  2. 2.Department of Gastroenterological Surgery (Surgery II)Nagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of Gastroenterological SurgeryAichi Cancer CenterNagoyaJapan
  4. 4.Department of SurgeryKomaki Municipal HospitalKomakiJapan
  5. 5.Department of SurgeryYokkaichi Municipal HospitalYokkaichiJapan
  6. 6.Department of SurgeryKonan Kosei HospitalKonanJapan
  7. 7.Department of SurgeryIchinomiya Municipal HospitalIchinomiyaJapan
  8. 8.Department of SurgeryGifu Prefectural Tajimi HospitalTajimiJapan
  9. 9.Department of SurgeryTosei General HospitalSetoJapan
  10. 10.Biostatistics Center, Graduate School of MedicineKurume UniversityKurumeJapan

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