5%. According to the National Cancer Institute, Surveillance, Epidemiology, and End Results Program (Bethesda, MD) database, the 2-year survival rate was only 22% to 42% in patients with
stage III gastric cancer , HCS assay which appears to be shorter than the results of the ACTS-GC and the CLASSIC trials. However, almost 70% of patients enrolled in this study had AJCC stage III disease, which was more advanced than the characteristics of those two trials. This difference may influence survival times. One controversial issue in the surgical management of gastric cancer is the optimal extent of lymph node dissection. Some large prospective clinical studies in western countries have shown that there was no difference in the 5-year survival rate among patients who underwent D1 versus D2 resection and that mortality related to surgery was higher in the D2 group ,  and . However, in Japan and other Asian countries, clinical studies have shown that the D2 operation can reduce postoperative local recurrence rates compared with D1 resection and that complication and operative mortality rates are very low . In this study, 22 patients (68.8%) received a D2 resection, and 10 patients (31.3%) underwent a D1 operation. The median DFS of these two groups was significantly different (15 months for D1 and
18 months for D2 dissections; P = .043), suggesting that D2 lymphadenectomy may provide a survival benefit. Selleckchem Natural Product Library This result may also suggest that patients who undergo a radical
D2 dissection may also benefit more from adjuvant DCF chemotherapy. For patients who have had a D1 resection, DCF adjuvant chemotherapy may not be effective enough. The addition Galactosylceramidase of radiotherapy in these subgroups may be of paramount importance on the basis of the results of the US Intergroup trial INT0116  and two recently published meta-analyses  and . This study showed that neutropenia and febrile neutropenia occurred most frequently in patients treated with adjuvant DCF chemotherapy. The incidence of grade 3/4 neutropenia was high (at 56.4%), and febrile neutropenia occurred in 12.5% of patients. Other grade 3/4 adverse events developed in less than 10% of patients. There were no chemotherapy-related deaths in our study. The adverse events were manageable, and nonhematologic AE were more tolerable than in some previous studies. In TAX-325, the rates of any grade 3 or 4 toxicity during therapy were high when triple therapy was used (81%), and the most frequent grade 3/4 adverse events were neutropenia (30%) and diarrhea (20%) . In summary, our results support the use of combination chemotherapy with DCF as a new approach to adjuvant treatment in patients with gastric cancer who have undergone radical surgery. We suggest further investigation of this adjuvant regimen. The authors report no conflicts of interest. The authors thank all the patients who participated in this study.