Department of Digestive Surgery, Angers University Hospital, Angers, France.
Ann Surg. 2011 Nov;254(5):684-93; discussion 693. doi: 10.1097/SLA.0b013e3182352647.
The aim of this retrospective study was to evaluate the survival impact of perioperative chemotherapy (PCT) in patients with gastric signet ring cell (SRC) adenocarcinoma.
PCT is a standard treatment for advanced resectable gastric adenocarcinoma (GA). SRC has a worse prognosis compared to non-SRC and the chemosensitivity of SRC is uncertain.
Among 3010 patients registered in 19 French centers between January 1997 and January 2010, 1050 (34.9%) were diagnosed with SRC. Of those treated with curative intent (n = 924), 171 (18.5%) received PCT with surgery (PCT group), whereas 753 (81.5%) were treated with primary surgery (S group). PCT was based mainly on a fluorouracil-platinum doublet or triplet regimen.
The groups were comparable regarding age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, tumor location and cTNM stage. 60 patients did not undergo resection because of tumor progression (10) or metastases (50) found at operation. The R0 resection rates were 65.9% and 62.3% in the S and PCT groups, respectively (P = 0.308). Fewer patients received adjuvant chemotherapy in the S group than in the PCT group (35.2% vs. 66.5%, P < 0.001). At a median follow-up of 31.5 months, the median survival was shorter in the PCT group (12.8 vs. 14.0 months, P = 0.043). On multivariate analysis, PCT was found to be an independent predictor of poor survival (HR = 1.4, 95% CI 1.1-1.9, P = 0.042).
PCT provides no survival benefit in patients with gastric SRC. Clinical Trial.gov record: ADCI001, Clinical Trial.gov identifier NCT01249859.
本回顾性研究旨在评估围手术期化疗（PCT）对胃印戒细胞腺癌（SRC）患者生存的影响。
PCT 是可切除晚期胃腺癌（GA）的标准治疗方法。与非 SRC 相比，SRC 的预后更差，SRC 的化疗敏感性尚不确定。
在 1997 年 1 月至 2010 年 1 月期间，19 个法国中心登记的 3010 例患者中，有 1050 例（34.9%）被诊断为 SRC。在接受根治性治疗的患者中（n = 924），有 171 例（18.5%）接受了手术联合 PCT（PCT 组），而 753 例（81.5%）接受了单纯手术（S 组）。PCT 主要基于氟尿嘧啶-铂类二联或三联方案。
两组在年龄、性别、美国麻醉医师协会（ASA）评分、营养不良、肿瘤位置和 cTNM 分期方面具有可比性。由于肿瘤进展（10 例）或术中发现转移（50 例），60 例患者未行切除术。S 组和 PCT 组的 R0 切除率分别为 65.9%和 62.3%（P = 0.308）。S 组接受辅助化疗的患者少于 PCT 组（35.2%比 66.5%，P < 0.001）。在中位随访 31.5 个月时，PCT 组的中位生存期较短（12.8 比 14.0 个月，P = 0.043）。多因素分析显示，PCT 是生存不良的独立预测因素（HR = 1.4，95%CI 1.1-1.9，P = 0.042）。
PCT 不能为胃 SRC 患者带来生存获益。临床试验注册：ADCI001，临床试验.gov 标识符 NCT01249859。
