Department of Oncology, Principe de Asturias Universitary Hospital, Alcalá University, Alcalá de Henares, Madrid, Spain.
Eur J Surg Oncol. 2013 Aug;39(8):814-22. doi: 10.1016/j.ejso.2013.05.003. Epub 2013 Jun 5.
Multimodal treatment for locally advanced gastric cancer has been reported to improve disease-free survival when compared to surgery alone. We aimed to clarify the efficacy and safety of perioperative chemotherapy for locally advanced gastric cancer patients treated in daily clinical practice.
Patients diagnosed with locally advanced gastric cancer were treated with perioperative chemotherapy and surgery. The primary end point was the complete resection (R0) rate. Secondary end points were disease-free survival (DFS), overall survival (OS), toxicity, radiological response rate, pathological response rate and downstaging rate. We also looked for prognostic and predictive factors for DFS, OS, pathological complete response and the R0 rate.
Forty patients were found eligible for this retrospective analysis. At diagnosis, 52.5% of patients were classified as stage II and 47.5% were stage III. Forty percent of patients completed three preoperative cycles and three postoperative cycles. A tolerable toxicity related to chemotherapy was found. Thirty-nine patients underwent surgery: 80% reached a complete resection (R0), down-staging was detected in 57.5% and 17.5% had a pathologically complete response. The median time of disease-free survival was 34.05 months (95%CI 25.6-42.4), and the median time of overall survival was 39.01 months (95%CI 30.8-47.1). We found that the presence of comorbidities were independent predictive factors for the pathologic response, while the chemotherapy schedule and the clinical response could independently predict a complete resection.
Our results support that perioperative chemotherapy for locally advanced gastric cancer can be safely delivered in daily clinical practice, obtaining an improvement of the pathologic response and the complete resection of gastric cancer.
与单独手术相比，局部晚期胃癌的多模式治疗已被报道可改善无病生存率。我们旨在阐明围手术期化疗对在日常临床实践中治疗的局部晚期胃癌患者的疗效和安全性。
诊断为局部晚期胃癌的患者接受围手术期化疗和手术治疗。主要终点是完全切除（R0）率。次要终点是无病生存率（DFS）、总生存率（OS）、毒性、影像学缓解率、病理缓解率和降期率。我们还寻找了DFS、OS、病理完全缓解和 R0 率的预后和预测因素。
发现 40 名患者符合本回顾性分析的条件。在诊断时，52.5%的患者分期为 II 期，47.5%的患者分期为 III 期。40%的患者完成了三个术前周期和三个术后周期。发现与化疗相关的毒性可耐受。39 名患者接受了手术：80%达到完全切除（R0），降期率为 57.5%，17.5%有病理完全缓解。无病生存的中位时间为 34.05 个月（95%CI 25.6-42.4），总生存的中位时间为 39.01 个月（95%CI 30.8-47.1）。我们发现合并症的存在是病理反应的独立预测因素，而化疗方案和临床反应可独立预测完全切除。
我们的结果支持局部晚期胃癌的围手术期化疗可以在日常临床实践中安全地进行，可提高胃癌的病理反应和完全切除率。
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