Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Cancer. 2012 Jan 1;118(1):248-57. doi: 10.1002/cncr.26248. Epub 2011 Jun 20.
A study was undertaken to determine the survival benefit of postoperative chemoradiation therapy for elderly patients with resected gastric adenocarcinoma.
The authors identified 1023 individuals aged 65 years and older (median = 76) who underwent gastrectomy for nonmetastatic stage IB-IV gastric adenocarcinoma diagnosed between 2000 and 2002 in the linked Surveillance, Epidemiology, and End Results-Medicare database. They examined factors associated with receiving postoperative chemoradiation and analyzed the survival benefit associated with receiving postoperative chemoradiation.
Thirty percent of patients received adjuvant chemoradiation. On multivariate analysis, younger age (P < .0001), lymph node involvement (P < .0001), and more recent diagnosis (P = .0284) were associated with receiving chemoradiation. There was a trend toward increased use among patients with less comorbidity (P = .0515). The median follow-up was 25.5 months, and 62% died. On multivariate survival analysis, older patients (P < .0001) and those with lymph node involvement (P < .0001), T3 or T4 disease (P = .0472), higher grade disease (P = .0355), and more comorbidity (P = .0411) were more likely to die. After adjustment for other factors, receipt of adjuvant chemoradiation therapy did not significantly increase survival (hazard ratio, 0.90; 95% confidence interval, 0.72-1.12; P = .3453) and did not increase survival in a multivariate analysis that included propensity scores (P = .2090).
The authors did not detect a survival benefit, suggesting that some elderly patients with resected gastric adenocarcinoma may not gain a survival benefit from the administration of adjuvant chemoradiation. The analysis had limitations, and the results are hypothesis generating. Future gastric cancer trials should enroll more elderly patients and stratify patients by age to better understand the impact of treatment regimens on older patients.
本研究旨在确定术后放化疗对接受根治性手术治疗的老年胃腺癌患者的生存获益。
作者在链接的监测、流行病学和最终结果-医疗保险数据库中，确定了 1023 名年龄在 65 岁及以上（中位年龄=76 岁）的个体，这些患者在 2000 年至 2002 年间被诊断为非转移性 IB-IV 期胃腺癌。他们检查了与接受术后放化疗相关的因素，并分析了接受术后放化疗与生存获益的相关性。
30%的患者接受了辅助放化疗。多变量分析显示，年龄较轻（P<0.0001）、淋巴结受累（P<0.0001）和较晚诊断（P=0.0284）与接受放化疗相关。在合并症较少的患者中，放化疗的使用率呈上升趋势（P=0.0515）。中位随访时间为 25.5 个月，62%的患者死亡。多变量生存分析显示，年龄较大（P<0.0001）、淋巴结受累（P<0.0001）、T3 或 T4 期疾病（P=0.0472）、高级别疾病（P=0.0355）和合并症较多（P=0.0411）的患者更有可能死亡。在校正其他因素后，接受辅助放化疗治疗并未显著提高生存（风险比，0.90；95%置信区间，0.72-1.12；P=0.3453），并且在包括倾向评分的多变量分析中也未提高生存（P=0.2090）。
作者未发现生存获益，这表明一些接受根治性手术治疗的老年胃腺癌患者可能无法从辅助放化疗中获得生存获益。该分析存在局限性，结果仅为初步结论。未来的胃癌临床试验应招募更多的老年患者，并按年龄分层患者，以更好地了解治疗方案对老年患者的影响。
