Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Ann Surg Oncol. 2012 Jul;19(7):2108-18. doi: 10.1245/s10434-011-2147-8. Epub 2011 Dec 1.
Preoperative chemotherapy has been shown to improve outcome of patients with adenocarcinoma of the esophagogastric junction (AEG) and gastric cancer (GC), and histopathologic response has been identified as an independent prognostic parameter in these patients. A recent meta-analysis has identified patients with AEG as benefiting more from preoperative chemotherapy than patients with GC. The aim of this retrospective analysis was to prove these findings in an experienced single-center large patient cohort because there are currently no recruiting prospective clinical trials.
In a single center, 551 patients underwent preoperative platin-based chemotherapy followed by oncologic surgery for locally advanced AEG and GC. Pretherapeutic clinical parameters were correlated with histopathologic response to preoperative chemotherapy.
Histopathologic response (<10% of residual tumor) was found in 130 patients (24%) and was significantly correlated with overall survival (P<0.0001). Tumor localization at the esophagogastric junction (GE junction), lower baseline cT stage, and baseline cN0 stage were significantly associated with histopathologic response (P=0.034, P=0.015, and P=0.002, respectively). In subgroup analyses, the latter two predictive parameters were confirmed only for AEG (n=378) but not for other GC (n=173). AEG patients who were pretherapeutically staged as having cT3/4, cN0 disease (n=73) were identified as the subgroup with the highest rate of histopathologic response (48%).
AEG is more likely to respond to preoperative chemotherapy than GC, a finding that might help identify patients who would benefit from preoperative chemotherapy.
术前化疗已被证明可改善食管胃结合部腺癌（AEG）和胃癌（GC）患者的预后，并且组织病理学反应已被确定为这些患者的独立预后参数。最近的一项荟萃分析确定 AEG 患者比 GC 患者从术前化疗中获益更多。本回顾性分析的目的是在经验丰富的单一中心大患者队列中证明这些发现，因为目前没有正在招募的前瞻性临床试验。
在一家单中心，551 名局部晚期 AEG 和 GC 患者接受了基于铂的术前化疗，然后进行了肿瘤学手术。将治疗前的临床参数与术前化疗的组织病理学反应相关联。
发现 130 名患者（24%）存在组织病理学反应（<10%的残余肿瘤），并且与总生存率显著相关（P<0.0001）。肿瘤位于食管胃结合部（GE 交界处）、较低的基线 cT 分期和基线 cN0 分期与组织病理学反应显著相关（P=0.034、P=0.015 和 P=0.002）。在亚组分析中，后两个预测参数仅在 AEG（n=378）中得到证实，而在其他 GC（n=173）中则没有。被预治疗分期为 cT3/4、cN0 疾病的 AEG 患者（n=73）被确定为组织病理学反应率最高（48%）的亚组。
AEG 比 GC 更有可能对术前化疗产生反应，这一发现可能有助于识别将从术前化疗中获益的患者。
