Comparative outcomes of adjuvant treatment approaches in resected stage I-III gastric cancer
- 1Department of Medical Oncology, Faculty of Medicine, Eskisehir Osmangazi University
Abstract
Background: Gastric cancer remains a major cause of cancer-related mortality. We evaluated clinicopathological prognostic factors and compared commonly used adjuvant treatment approaches after curative resection.
Methods: This retrospective study included 277 patients with stage I-III gastric cancer treated with adjuvant chemotherapy with or without chemoradiotherapy between 2006 and 2022. Treatment groups were defined by systemic chemotherapy regimen: fluorouracil plus folinic acid (FUFA), capecitabine plus oxaliplatin (XELOX), or cisplatin-based chemotherapy. Concurrent chemoradiotherapy was administered to 98.7%, 81.0%, and 92.9% of patients, respectively.
Results: The FUFA, XELOX, and cisplatin-based groups comprised 156, 58, and 28 patients. Advanced stage, ECOG performance status ≥2, R1 resection, extracapsular extension, high grade, lymphatic invasion, perineural invasion, tumor nodules, and treatment discontinuation were associated with shorter disease-free survival (DFS) and overall survival (OS). In multivariable analysis, pathological stage and perineural invasion remained independently associated with survival. Compared with FUFA, XELOX was associated with lower hazards of recurrence (HR = 0.48, 95% CI: 0.29–0.80; p=0.005) and mortality (HR = 0.48, 95% CI: 0.28–0.82; p=0.007), whereas the cisplatin-based approach did not differ significantly from the FUFA reference group. When treatment period was forced into the models, the DFS association for XELOX was no longer statistically significant (HR = 0.40, 95% CI: 0.15–1.04; p=0.060), whereas the OS association remained significant (HR = 0.32, 95% CI: 0.12–0.87; p=0.026). In unadjusted pairwise comparisons, FUFA and XELOX did not differ significantly in DFS or OS in the overall cohort. In the exploratory analysis of node-positive patients, XELOX and FUFA also did not differ significantly in DFS or OS (p=0.088 and p=0.132). All-grade neutropenia, diarrhea, and neuropathy differed significantly among treatment groups; no treatment-related deaths occurred.
Conclusions: FUFA and XELOX did not differ significantly in DFS or OS in unadjusted pairwise comparisons overall or in the exploratory analysis of node-positive patients. However, XELOX was associated with lower recurrence and mortality hazards in the primary multivariable models; in the treatment-period-forced sensitivity analysis, the DFS association was no longer statistically significant, whereas the OS association remained significant. This discordance for DFS should be interpreted cautiously because treatment approach and treatment period were closely linked, making a clear causal interpretation difficult.
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BibTeX
@article{yildiz2026comparative,
title = {{Comparative outcomes of adjuvant treatment approaches in resected stage I-III gastric cancer}},
author = {Bulent Yildiz and Yasemin Sagdic Karateke and Duygu Bayir Garbioglu and Metin Demir},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1933478},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1933478/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative outcomes of adjuvant treatment approaches in resected stage I-III gastric cancer
AU - Bulent Yildiz
AU - Yasemin Sagdic Karateke
AU - Duygu Bayir Garbioglu
AU - Metin Demir
PY - 2026
DA - 2026/10/20
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1933478
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1933478/full
AB - Background: Gastric cancer remains a major cause of cancer-related mortality. We evaluated clinicopathological prognostic factors and compared commonly used adjuvant treatment approaches after curative resection. Methods: This retrospective study included 277 patients with stage I-III gastric cancer treated with adjuvant chemotherapy with or without chemoradiotherapy between 2006 and 2022. Treatment groups were defined by systemic chemotherapy regimen: fluorouracil plus folinic acid (FUFA), capecitabine plus oxaliplatin (XELOX), or cisplatin-based chemotherapy. Concurrent chemoradiotherapy was administered to 98.7%, 81.0%, and 92.9% of patients, respectively. Results: The FUFA, XELOX, and cisplatin-based groups comprised 156, 58, and 28 patients. Advanced stage, ECOG performance status ≥2, R1 resection, extracapsular extension, high grade, lymphatic invasion, perineural invasion, tumor nodules, and treatment discontinuation were associated with shorter disease-free survival (DFS) and overall survival (OS). In multivariable analysis, pathological stage and perineural invasion remained independently associated with survival. Compared with FUFA, XELOX was associated with lower hazards of recurrence (HR = 0.48, 95% CI: 0.29–0.80; p=0.005) and mortality (HR = 0.48, 95% CI: 0.28–0.82; p=0.007), whereas the cisplatin-based approach did not differ significantly from the FUFA reference group. When treatment period was forced into the models, the DFS association for XELOX was no longer statistically significant (HR = 0.40, 95% CI: 0.15–1.04; p=0.060), whereas the OS association remained significant (HR = 0.32, 95% CI: 0.12–0.87; p=0.026). In unadjusted pairwise comparisons, FUFA and XELOX did not differ significantly in DFS or OS in the overall cohort. In the exploratory analysis of node-positive patients, XELOX and FUFA also did not differ significantly in DFS or OS (p=0.088 and p=0.132). All-grade neutropenia, diarrhea, and neuropathy differed significantly among treatment groups; no treatment-related deaths occurred. Conclusions: FUFA and XELOX did not differ significantly in DFS or OS in unadjusted pairwise comparisons overall or in the exploratory analysis of node-positive patients. However, XELOX was associated with lower recurrence and mortality hazards in the primary multivariable models; in the treatment-period-forced sensitivity analysis, the DFS association was no longer statistically significant, whereas the OS association remained significant. This discordance for DFS should be interpreted cautiously because treatment approach and treatment period were closely linked, making a clear causal interpretation difficult.
SN - 2234-943X
ER -