[Long-term outcome of preoperative chemotherapy with 5'-deoxy-5-fluorouridine (5'-DFUR) for gastric cancer]

Abstract

We performed a multicenter clinical trial of preoperative chemotherapy for gastric cancer. Patients aged 75 years or less with advanced gastric cancer were enrolled and randomized into the following groups: Group I, which received oral 5'-DFUR (610 mg/m2/day x 10 days or over) preoperatively, and Group II, which received no treatment preoperatively. Patients in both groups also received intravenous MMC 1 and 2 days after surgery and were orally administered 5'-DFUR for two years postoperatively. There were 171 patients (Group I: 91, Group II: 80) enrolled and analyzed, and the 5-year survival rate was 63.4% in Group I and 64.9% in Group II (p = 0.698). Among patients classified as having curability B, the 5-year survival rate of each group was 51.8% and 36.8%, respectively (p = 0.426). However, the 5-year survival rate of patients showing good compliance with oral 5'-DFUR therapy was significantly higher than that of patients with poor compliance (53.3% vs 22.0%, p = 0.010). The pyrimidine nucleoside phosphorylase (PyNPase) activity in gastric carcinoma tissue from Group I was lower than that from Group II, and Group II patients tended to die of hematogeneous metastases. In conclusion, although this clinical trial failed to demonstrate a significant benefit of preoperative chemotherapy because of the low dose of 5'-DFUR, we believe that good compliance with oral anticancer treatment contributes to long-term survival and that 5'-DFUR reduces hematogeneous metastasis of gastric carcinoma.