ABSTRACT
BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Registries , Stomach Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Clinical Decision-Making , Female , Humans , Maintenance Chemotherapy , Male , Middle Aged , Platinum/administration & dosage , Platinum/adverse effects , Progression-Free Survival , Pyrimidines/administration & dosage , Pyrimidines/adverse effects , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Survival Rate , Time Factors , Young AdultABSTRACT
The aim of this study was to know if cholecystectomy rates have decreased in young women, considering that these rates have decreased in the last years in the general chilean population. The frequency of previous cholecystectomy was compared in 1582 women aged 23.9 +/- 5.8 years admitted to a maternity for delivery between 1985 and 1986 and 4943 women aged 24.6 +/- 5.9 years admitted between 1989 and 1990 for the same reason. There was a reduction in cholecystectomy frequency from 4.7 to 2.5% specially among women 21 to 35 years old. Cholecystectomy was performed at a mean age of 23 years in both groups and 42.6% of the procedures were done before the first pregnancy. An unexpected finding was a lower body weight among women studied in the second period (62.5 +/- 9.1 vs 67.7 +/- 8.4 k).
