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Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) as preoperative and postoperative chemotherapy compared with surgery followed by chemotherapy for patients with locally advanced gastric cancer: a propensity score-based analysis

Authors Wang KS, Ren YX, Ma ZJ, Li F, Cheng XC, Xiao JY, Zhang SZ, Yu ZY, Yang HT, Zhou HN, Li YM, Liu HB, Jiao ZY

Received 8 January 2019

Accepted for publication 15 February 2019

Published 10 April 2019 Volume 2019:11 Pages 3009—3020

DOI https://doi.org/10.2147/CMAR.S200883

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 3

Editor who approved publication: Dr Ahmet Emre Eskazan


Keshen Wang,1 Yanxian Ren,1 Zhijian Ma,2 Fan Li,1 Xiaocheng Cheng,1 Jingying Xiao,1 Shuze Zhang,1 Zeyuan Yu,1 Hanteng Yang,1 Huinian Zhou,1,2 Yuming Li,1,2 Hongbin Liu,3 Zuo-Yi Jiao1,2

1Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730010, People’s Republic of China; 2Cui-ying Experimental Center, Lanzhou University Second Hospital, Lanzhou, Gansu 730010, People’s Republic of China; 3Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of People’s Liberation Army, Lanzhou 730050, People’s Republic of China

Introduction: Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) may improve overall survival (OS) in patients with locally advanced gastric cancer (LAGC); however, evidence for its use as a standard treatment has not been established in China. The aim of this study was to investigate the effectiveness, safety, and feasibility of the FLOT regimen as neoadjuvant chemotherapy in Chinese patients with resectable LAGC.
Methods: We conducted an observational study to compare the effectiveness of FLOT regimen consisting of docetaxel (60 mg/m2,), oxaliplatin (85 mg/m2,), leucovorin (200 mg/m2,), and 5-fluorouracil (2,600 mg/m2, as a 24 hr infusion), all given on day 1 and administered every 2 weeks versus initial surgery followed by chemotherapy in patients with clinical T3–4 LAGC. OS was compared by using the Cox proportional hazards regression model and the Kaplan–Meier curve adjusted by inverse probability of treatment weighting (IPTW) and propensity score-matched (PSM) analysis. In addition, we performed subgroup analyses to determine the effectiveness of the FLOT regimen in clinically relevant patient subsets.
Results: Overall, 47 patients who received initial FLOT chemotherapy and 269 patients who received initial surgery were enrolled in this study. In the PSM analysis, the FLOT-first group showed favorable OS compared with the surgery-first group (41 vs 41 [HR, 0.416; 95% CI, 0.218–0.794; P=0.008]), and 3-year survival rates were 58.7% and 30.9% in the FLOT-first group and surgery-first group, respectively. IPTW analysis showed similar results. However, the effect of FLOT was low (HR, 0.868; 95 CI%, 0.215–3.504) in patients without lymph node metastasis.
Conclusion: Our study suggests that preoperative FLOT chemotherapy is safe and feasible. In terms of OS, FLOT may be superior to initial surgery followed by chemotherapy in reducing morbidity with resectable LAGC.

Keywords: gastric cancer, preoperative chemotherapy, propensity score, FLOT, prognosis


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