Wang Yan, Liu Tian-shu, Zhuang Rong-yuan, Cui Yue-hong, Wang Zhi-ming, Yu Yi-yi, Hou Jun, Sun Yi-hong, Shen Kun-tang, Shen Zhen-bin
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2013 Feb;16(2):166-9.
To evaluate the efficacy and safety of neoadjuvant chemotherapy in patients with locally advanced gastric cancer, and to analyze the relevant factors of recurrent death of gastric cancer after adjuvant chemotherapy.
Clinical data of 49 patients who underwent neoadjuvant chemotherapy for locally advanced gastric cancer between July 2007 and June 2011 were reviewed. Preoperative staging was determined by endoscopic ultrasonography and abdominal computer tomography (CT) or magnetic resonance imaging (MRI). Chemotherapy was administered for regimen of two or three drugs. Prognostic factors were analyzed by univariate and multivariate analysis with Cox proportional hazard model.
The response rate was 33.3% (16/48) and disease control rate was 93.8% (45/48). Forty-four (89.8%, 44/49) patients received curative resection after neoadjuvant chemotherapy, among whom 90.9% (40/44) underwent D2 lymphadenctomy. Thirty-two cases had pathological response and 2 patients had pathological complete response. The average hospital stay was 11.6 days and 2 patients had longer hospitalization because of postoperative pancreatic complications. The toxicities were most in grade 1-2. All the patients were followed up postoperatively and the median follow-up was 21.6 months. Median progression-free survival was 29.6 (95%CI:24.0-35.2) months and median overall survival was 34.6 months (95%CI:29.8-39.4). Imaging response (P=0.038, RR=0.168, 95%CI:0.031-0.904) and pathological response (P=0.007, RR=0.203, 95%CI:0.064-0.642) were identified as independent prognostic factors with COX multivariate analysis.
Neoadjuvant chemotherapy has quite high disease control rate and R0 resecting rate for patients with locally advanced gastric cancer. Imaging response and pathological response are most important prognostic factors in those patients.
评估新辅助化疗对局部进展期胃癌患者的疗效和安全性，并分析辅助化疗后胃癌复发死亡的相关因素。
回顾性分析2007年7月至2011年6月期间49例行新辅助化疗的局部进展期胃癌患者的临床资料。术前分期通过超声内镜及腹部计算机断层扫描（CT）或磁共振成像（MRI）确定。化疗采用两药或三药方案。采用Cox比例风险模型进行单因素和多因素分析以确定预后因素。
有效率为33.3%（16/48），疾病控制率为93.8%（45/48）。44例（89.8%，44/49）患者在新辅助化疗后接受了根治性切除，其中90.9%（40/44）行D2淋巴结清扫术。32例有病理反应，2例有病理完全缓解。平均住院时间为11.6天，2例患者因术后胰腺并发症住院时间延长。毒性反应大多为1 - 2级。所有患者术后均接受随访，中位随访时间为21.6个月。中位无进展生存期为29.6（95%CI：24.0 - 35.2）个月，中位总生存期为34.6个月（95%CI：29.8 - 39.4）。经COX多因素分析，影像学反应（P = 0.038，RR = 0.168，95%CI：0.031 - 0.904）和病理反应（P = 0.007，RR = 0.203，95%CI：0.064 - 0.642）被确定为独立预后因素。
新辅助化疗对局部进展期胃癌患者具有较高的疾病控制率和R0切除率。影像学反应和病理反应是这些患者最重要的预后因素。
