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The standard of care for T3 or node-positive gastric cancer combines surgery with adjuvant therapy, including the use of pre- and postoperative chemotherapy with or without postoperative radiotherapy. However, recent studies have revisited the use of adjuvant chemotherapy alone in gastric cancer. A recent pooled analysis showed a survival benefit for adjuvant chemotherapy versus surgery only (JAMA 2010; 303:1729). Also, the prior Adjuvant Chemotherapy Trial for S-1 for Gastric Cancer (ACTS-GC) indicated a relapse-free survival benefit at a median follow-up of 3 years for patients with stage II and III gastric cancer who received a 1-year course of adjuvant therapy with S-1 — which combines tegafur (an oral 5-fluorouracil [5-FU] prodrug), gi…