Department of Surgery, Hanyang University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2009 Mar;41(1):19-23. doi: 10.4143/crt.2009.41.1.19. Epub 2009 Mar 31.
The optimal chemotherapeutic strategy for gastric cancer patients has not been determined, especially with respect to stage and the curability of gastric cancer. The aim of this study was to evaluate the results of adjuvant chemotherapy on stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer after curative gastrectomy between a chemotherapy (CTX) group and non-chemotherapy (non-CTX) group.
Among 1,760 patients who underwent gastric surgery by 1 surgeon in a single institution, 162 stage IV gastric cancer patients with curative gastrectomy were analyzed retrospectively, excluding patients with TanyNanyM1. One hundred twenty-five patients who received different chemotherapeutic regimens were compared to 37 patients who did not receive chemotherapy for reasons of old age or according to their expressed desire.
The clinicopathologic factors which showed a clinically significant difference between the two groups were age and histology, which were not associated with patient survival. The CTX group was younger, and had a larger proportion of undifferentiated gastric cancers than the non-CTX group. The mode of treatment failure revealed no significant difference between the CTX and non-CTX groups. The 1, 3, and 5-year disease-free survival and the 1, 3, and 5-year disease-specific survival of the CTX group were 63.9%, 38.4%, and 32.0%, and 85.4%, 52.3%, and 39.6%, respectively, which were more favorable than the non-CTX group (p=0.015 and p=0.001, respectively). Postoperative adjuvant CTX was an independent risk factor for disease-specific survival of stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer patients after curative gastrectomy by multivariate analysis (odds ratio=2.153; 95% confidence interval=1.349-3.435; p=0.001).
Adjuvant CTX may be associated with survival benefit for younger patients with stage IV (T4N1-3M0 and T1-3N3M0) gastric cancer with undifferentiated histology after curative gastrectomy. A randomized controlled trial to reveal the effect of stage-specific adjuvant chemotherapy should be conducted.
对于胃癌患者，尚未确定最佳化疗策略，尤其是在胃癌分期和可治愈性方面。本研究旨在评估根治性胃切除术后 IV 期（T4N1-3M0 和 T1-3N3M0）胃癌患者接受辅助化疗（CTX）与非化疗（非 CTX）治疗的结果。
在 1 名外科医生在单个机构进行的 1760 例胃癌手术患者中，回顾性分析了 162 例经根治性胃切除术后的 IV 期胃癌患者，排除了 TanyNanyM1 的患者。将接受不同化疗方案的 125 例患者与 37 例因年龄较大或根据其意愿未接受化疗的患者进行比较。
两组之间具有临床显著差异的临床病理因素为年龄和组织学，与患者生存无关。CTX 组年龄较小，且未分化型胃癌的比例高于非 CTX 组。CTX 组和非 CTX 组的治疗失败模式无显著差异。CTX 组的 1、3 和 5 年无病生存率和 1、3 和 5 年疾病特异性生存率分别为 63.9%、38.4%和 32.0%，85.4%、52.3%和 39.6%，均优于非 CTX 组（p=0.015 和 p=0.001）。多因素分析显示，术后辅助 CTX 是根治性胃切除术后 IV 期（T4N1-3M0 和 T1-3N3M0）胃癌患者疾病特异性生存的独立危险因素（优势比=2.153；95%置信区间=1.349-3.435；p=0.001）。
对于根治性胃切除术后具有未分化组织学的年轻 IV 期（T4N1-3M0 和 T1-3N3M0）胃癌患者，辅助 CTX 可能与生存获益相关。应进行随机对照试验以揭示特定分期辅助化疗的效果。
