Effects of Adjuvant Immunochemotherapy in Stage III Gastric Cancer

ABSTRACT

BACKGROUND: To evaluate the effectiveness of early postoperative adjuvant immunochemotherapy in a stage III (UICC, 1997) primary gastric carcinomas we analyzed cases histories of 140 patients retro spectively who had undergone curative gastrectomy at Wonkwang University Hospital from November 1988 to November 1995. METHODS: For immunotherapy, OK-432 intramuscularly or oral PSK was used for 2 months, and for chemotherapy, FAM (8 week cycle) or oral 5-FU derivatives and MMC were used for 6 months or longer. Immunotherapy was started at the 5th postoperative day and chemotherapy at the 7th to 10th postoperative day. Sixty-eight (68) patients received immunochemotherapy (therapy group; TG) and 72 patients did not (nontherapy group; NTG). Statistical analysis were carried out with Anova, Kaplan-Meier, and Log rank test. RESULTS: One hundred eight (108) patients were male, and 84 patients were younger than 60 years. Eighty-one (81) cases involves the lower stomach and 52 the middle stomach. Lymphatic invasion was seen in 60 cases. Twenty-five (25) cases were T2, 112 T3, 42 N1, 90 N2, 75 stage IIIa, and 65 stage IIIb. The overall 5-year survival rate was 48.6% (stage IIIa 58.7%, stage IIIb 36.9%, p<0.05). The 5-year survival rates for the TG and the NTG were 52.9% and 44.4%, respectively (p=0.10). The 5-year survival rates were 85.7% (n=18) and 85.7% (n=7) in T2, 54.0% (n=50) and 40.3% (n=62) in T3 (p<0.05), 69.6% (n=23) and 50.0% (n=24) in N1, 44.4% (n=45) and 42.2% (n=45) in N2 (p=0.14), 61.0% (n=41) and 55.9% (n=34) in stage IIIa, 40.7% (n=27) and 34.2% (n=38) in stage IIIb (p=0.16), 59.5% (n=37) and 48.8% (n=43) in the non-lymphatic invasion group, and 45.2% (n=31) and 37.9% (n=29) in the lymphatic invasion group (p=0.09). There was no significant difference in the 5-year survival rates of the other parameters, such as age, sex, tumor location, size, gross finding, tumor differentiation, between the TG and the NTG. CONCLUSION: The survival rate in the early postoperative immunochemotherapy group was not signi ficantly increased compared to that in the nontherapy group for stage III gastric cancer, but the immuno chemotherapy group showed a tendency for a higher 5-year survival than the nontherapy group did.