Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
J Surg Res. 2012 Dec;178(2):623-31. doi: 10.1016/j.jss.2012.04.062. Epub 2012 May 16.
The role of neoadjuvant and adjuvant therapy for gastric cancer remains undefined. We compared the outcomes for patients treated with surgery alone or with the addition of adjuvant or neaodjuvant treatment.
A single-institution, retrospective evaluation of a prospective database of gastric cancer patients treated from 2000 to 2008 was performed.
Overall, 173 patients with gastric cancer underwent surgical extirpation. Of the 173 patients, 43% had early-stage disease (less than stage 2) and 57% had late-stage disease (stage 2 or greater; American Joint Committee on Cancer, 2010). The median survival from the date of diagnosis for those treated with neoadjuvant chemotherapy (NAC) (n = 35), adjuvant chemotherapy (n = 21), adjuvant chemoradiotherapy (n = 18), both NAC and adjuvant chemotherapy (n = 11), or surgery alone (n = 88) was 26.3, 17.3, greater than 60, greater than 60, and 50.3 months, respectively. The addition of NAC to surgery was detrimental to survival in those with early-stage disease (P = 0.002) and did not improve survival in those with late-stage disease (P = 0.687). For those with late-stage disease, surgery with adjuvant chemoradiotherapy exhibited the best overall survival compared with surgery alone (P = 0.021) or surgery with adjuvant chemotherapy (P = 0.01). Patients treated with NAC had a greater rate of R0 resection compared with surgery alone (P = 0.049).
NAC for patients with gastric cancer does not significantly improve the overall outcomes for those with late-stage disease and could be detrimental to survival for those with early-stage disease. However, treatment with NAC resulted in an improved rate of R0 resection.
新辅助和辅助治疗在胃癌中的作用仍未确定。我们比较了单独手术治疗与辅助或新辅助治疗联合治疗患者的结果。
对 2000 年至 2008 年接受手术治疗的胃癌患者的前瞻性数据库进行了单中心回顾性评估。
共有 173 例胃癌患者接受了手术切除。在这 173 例患者中，43%为早期疾病（分期小于 2 期），57%为晚期疾病（分期 2 期或更晚；美国癌症联合委员会，2010 年）。接受新辅助化疗（NAC）（n=35）、辅助化疗（n=21）、辅助放化疗（n=18）、NAC 联合辅助化疗（n=11）或单纯手术（n=88）治疗的患者，从诊断日期起的中位生存时间分别为 26.3、17.3、大于 60、大于 60 和 50.3 个月。对于早期疾病患者，NAC 联合手术治疗对生存不利（P=0.002），但对晚期疾病患者的生存无改善（P=0.687）。对于晚期疾病患者，与单纯手术治疗（P=0.021）或单纯手术治疗联合辅助化疗（P=0.01）相比，手术联合辅助放化疗的总体生存率最佳。与单纯手术治疗相比，接受 NAC 治疗的患者 R0 切除率更高（P=0.049）。
NAC 治疗胃癌患者不能显著改善晚期疾病患者的总体结局，并且可能对早期疾病患者的生存不利。然而，NAC 治疗可提高 R0 切除率。
