S-1用于輔助化療的依從性不強(qiáng)，針對這種情況，日本神奈川癌癥中心Toru Aoyama博士進(jìn)行了一項(xiàng)研究，其研究目的為，對胃切除術(shù)后S-1繼續(xù)用藥的風(fēng)險(xiǎn)因素進(jìn)行闡述。該項(xiàng)研究結(jié)果已在2012年12月16日在線出版的《外科腫瘤學(xué)年鑒》(Annals of Surgical Oncology)雜志上得到了發(fā)表。

　　該項(xiàng)研究回顧性地篩選了曾接受根治性D2手術(shù)的胃癌患者，經(jīng)過診斷，參試患者病情為2/3期，肌酐清除率大于60 ml/min，并且于2002年6月至2011年12月期間，這些患者在本研究單位接受了S-1輔助化療。研究人員同時(shí)對S-1治療失敗時(shí)間(TTF)進(jìn)行了測算。

　　最終，共有103例患者被篩選進(jìn)入該研究。經(jīng)過對TTF曲線進(jìn)行各臨床因素分層分析，并經(jīng)對數(shù)秩檢驗(yàn)對比后，研究人員發(fā)現(xiàn)，體重減輕(BWL)15%可視作臨界點(diǎn)。單變量及多變量Cox比例風(fēng)險(xiǎn)分析均表明，體重減輕為顯著獨(dú)立性風(fēng)險(xiǎn)因素。此外，在對包括8例因復(fù)發(fā)而中止S-1治療患者亞群進(jìn)行的單變量及多變量分析表明，體重減輕也仍是一個(gè)顯著因素。對于BWL < 15的患者，6個(gè)月繼續(xù)用藥率為66.4 %，而BWL ≥ 15 %的患者為36.4 %(P =0.017)。

　　Toru Aoyama博士最終認(rèn)為，對2/3期接受D2胃切除術(shù)的胃癌患者，體重減輕為通過S-1輔助化療依從性最重要的風(fēng)險(xiǎn)因素。因此，為改善藥物依從性，從而提高患者存活時(shí)間，關(guān)鍵需要在進(jìn)行S-1輔助化療前保持患者體重。該項(xiàng)研究同時(shí)強(qiáng)調(diào)，對于因晚期胃癌而接受胃切除術(shù)的患者，需要針對圍手術(shù)期營養(yǎng)干預(yù)進(jìn)行更加充分的研究。

　　Risk Factors for Peritoneal Recurrence in Stage II/III Gastric Cancer Patients Who Received S-1 Adjuvant Chemotherapy After D2 Gastrectomy

　　Toru Aoyama MD, Takaki Yoshikawa MD, PhD, Tsutomu Hayashi MD, Hiroshi Kuwabara MD, Yo Mikayama MD, Takashi Ogata MD, PhD, Haruhiko Cho MD, PhD, Akira Tsuburaya MD, PhD

　　Background The peritoneum is still the most frequent site of recurrence in stage II/III gastric cancer patients, although the survival rate was improved by the introduction of S-1 adjuvant chemotherapy. The objective of this retrospective study was to clarify the risk factors for peritoneal recurrence in patients who received S-1 adjuvant chemotherapy. Methods Peritoneal recurrence-free survival was examined in 100 gastric cancer patients who underwent curative D2 surgery, which were diagnosed with stage II or III disease pathologically, and received adjuvant S-1 between June 2002 and March 2011. The univariate and multivariate analyses were performed to identify risk factors by a Cox proportional hazards analysis. Results The P-RFS was 64.3% at 3 years and 58.8% at 5 years. A total of 18 patients were diagnosed with peritoneal recurrence. The macroscopic tumor diameter, depth of tumor invasion, and lymph node metastasis were the significant factors identified by the univariate analysis, while the tumor diameter and lymph node metastasis were the only significant independent risk factors identified by the multivariate analysis. Conclusions The macroscopic tumor diameter and presence of lymph node metastasis were the most important risk factors for peritoneal recurrence. When patients had these risk factors, S-1 was not sufficient to inhibit peritoneal recurrence. A novel adjuvant chemotherapeutic agent targeting peritoneal metastasis in these patients should be developed.