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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

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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.

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Author information

Authors and Affiliations

  1. Department of Surgery, Okazaki City Hospital, Okazaki, Japan

    Akimitsu Iizuka & Akiharu Ishiyama

  2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Mitsuro Kanda, Chie Tanaka, Daisuke Kobayashi, Michitaka Fujiwara & Yasuhiro Kodera

  3. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Seiji Ito

  4. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan

    Yoshinari Mochizuki

  5. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan

    Hitoshi Teramoto

  6. Department of Surgery, Konan Kosei Hospital, Konan, Japan

    Kiyoshi Ishigure

  7. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan

    Toshifumi Murai

  8. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan

    Takahiro Asada

  9. Department of Surgery, Tosei General Hospital, Seto, Japan

    Hidenobu Matsushita

  10. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan

    Kenta Murotani

Authors
  1. Akimitsu Iizuka
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  2. Mitsuro Kanda
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  15. Yasuhiro Kodera
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Corresponding author

Correspondence to Mitsuro Kanda.

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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

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Iizuka, A., Kanda, M., Ito, S. et al. 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. World J Surg 43, 2016–2024 (2019). https://doi.org/10.1007/s00268-019-04942-y

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  • DOI: https://doi.org/10.1007/s00268-019-04942-y

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