| BACKGROUNDFluoropyrimidine is commonly used in treating gastric cancer, and the oral fluoropyrimidines (Tegafur/Gimeracil/Oteracil and capecitabine) are recommended for treating old patients or patients with poor performance status because of their better anticancer efficacy, more convenient administration, and less adverse effects. Oxaliplatin is also recommended in the combination chemotherapy because it has less adverse reactions and no cross-resistance with cisplatin. However, there is no conclusion on the comparison of the two oral fluoropyrimidines in combination with oxaliplatin for first-line treatment of AGC patients.OBJECTIVEThis research aims to compare the efficacy and safety of Tegafur/Gimeracil/Oteracil or capecitabine in combination with oxaliplatin for firstline treatment of AGC patients, analyze the influencing factors, and provide further evidence in treating gastric cancer.METHODSPatients diagnosed as inoperable gastric cancer in the Cancer Center of Qilu Hospital, Shandong University from January2011to January2014were collected. The disease was confirmed by pathologic and/or cytologic methods. The patients were collected into2groups according to the treatments:(1) Tegafur/Gimeracil/Oteracil+Oxaliplatin Group (Group A):Tegafur/Gimeracil/Oteracil40mg/m, bid, dl-14; oxaliplatin130mg/m2, dl,21days for a cycle;(2)Capecitabine+Oxaliplatin Group (Group B): capecitabine1000mg/m2, bid, dl-14; oxaliplatin130mg/m2, dl,21days for a cycle. Efficacy and safety were evaluated according to RECIST1.1and CTCAE4.0after treating for two cycles. Statistical analysis was performed using the SPSS19.0.RESULTSResults:1. Efficacy:Group A:overall response rate(ORR)56.1%, disease control rate (DCR)73.2%; Group B:ORR54.5%, DCR75.8%, showing no statistical difference (P=0.894and P=0.800);2. Survival analysis:Group A:median PFS6.1months, median OS16.3months; Group B:median PFS4.9months, median OS14.8months, showing no statistical difference (P=0.660and P=0.699).3. No statistical difference was shown concerning the adverse drug reactions. The incidence of diarrhea and hand-foot syndrome was higher in Group B than in Group A (27.3%vs12.9%, P=0.049and33.3%vs9.8%, P=0.012respectively), but the cost in Group B was less than that in Group A.4. Pathological staging (P=0.028), gastrectomy (P=0.002), locoregional recurrence (P=0.001) were related to the efficacy of Group A. Age (P=0.041), pathological staging (P=0.006), lymph nodes status (P=0.006), gastrectomy (P=0.008) were related to the efficacy of Group B. But the independent influencing factors could not be decided.5. Age (OR=2.216, P=0.026), histological staging (OR=0.292, P<0.001), and lymph nodes status (OR=2.302, P=0.014) were the independent influencing factors in the prognosis of gastric cancer.CONCLUSION1. Tegafur/Gimeracil/Oteracil or capecitabine plus oxaliplatin regimens showed a similar efficacy with moderate advance effects in treating advanced gastric cancer patients. Capecitabine plus oxaliplatin regimen had a higher rate of adverse events such as the diarrhea and hand-foot syndrome but a less cost.2. Pathological staging, gastrectomy, locoregional recurrence were related to the efficacy of Group A. Age, pathological staging, lymph nodes status, gastrectomy were related to the efficacy of Group B. But the independent influencing factors could not be decided.3. Age, lymph nodes status were the independent risk factors of long-term survival, and the histological staging and pathological staging were the independent protective factors of long-term survival in gastric cancer.4. These data should be warranted with further prospective randomized controlled studies, and a comprehensive analysis on the influencing factors should be performed in order to establish an effective model in predicting the efficacy of gastric cancer treatment. |
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