Gastinger I, Windisch J, Meyer F, Ptok H, Steinert R, Otto R, Bruns C, Lippert H
AN-Institut für Qualitätssicherung in der Operativen Medizin, Otto-von-Guericke- Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland,
Chirurg. 2015 Jun;86(6):570-6. doi: 10.1007/s00104-014-2788-9.
Data are available on two multicenter observational studies, the East German Gastric Cancer Study (EGGCS) '02 (surgical interventions only) and the German Gastric Cancer Study II (QCGC) from 2007 to 2009 (after inauguration of multimodal therapeutic concepts) with regard to palliative treatment of advanced gastric cancer. Through the first investigation period from January to December 2002 (EGGCS) overall 1139 patients with primary gastric cancer were registered and evaluated and then from 2007 to 2009 (QCGC) another 2897 patients were included. Comparing both time periods, there were no significant changes in the distribution of tumor sites and stages according to the Union Internationale Contre le Cancer (UICC) classification, in particular, there was no significant reduction of advanced tumor stages. From 2007 to 2009 in total 521 patients (18 %) received neoadjuvant therapy, 401 patients (13.9 %) out of the group with curative intention and 120 (4.1 %) out of the group of patients with palliative intention. The proportion of palliative patients who underwent chemotherapy (with neoadjuvant intention and/or postoperatively) was 32.5 % (n = 223). Thus, the rate of palliative treatment (rate of no R0 resection status 29.6 %, rate of patients who did not undergo surgical intervention at all 9.5 %) could be diminished from almost 40 % in 2002 to 24.5 % through the time period from 2007 to 2009. Taking all patients together (with curative and palliative intention) an increase of the 4-year survival probability from 40.0 % to 48.5 % was observed after inauguration of multimodal therapy. After a 5-year follow-up median survival time was 34 months during the investigation period from 2007 to 2009 considering all study subjects. Patients who had undergone palliative surgical interventions benefited from postoperative palliative chemotherapy; however, as expected this was of greater benefit to patients with resecting surgical interventions than those with non-resecting operations. Palliative tumor resection (even R2 resection status) should be part of a concept of multimodal palliative therapy in cases of acceptable perioperative risk.
现有两项多中心观察性研究的数据，即东德胃癌研究（EGGCS）'02（仅手术干预）和2007年至2009年的德国胃癌研究II（QCGC）（多模式治疗概念启用后），涉及晚期胃癌的姑息治疗。在2002年1月至12月的第一个调查期（EGGCS），共登记并评估了1139例原发性胃癌患者，然后在2007年至2009年（QCGC）又纳入了2897例患者。比较两个时间段，根据国际抗癌联盟（UICC）分类，肿瘤部位和分期的分布没有显著变化，特别是晚期肿瘤分期没有显著减少。2007年至2009年，共有521例患者（18%）接受了新辅助治疗，其中401例（13.9%）来自有治愈意向的组，120例（4.1%）来自有姑息意向的组。接受化疗（有新辅助意向和/或术后）的姑息患者比例为32.5%（n = 223）。因此，姑息治疗率（无R0切除状态率29.6%，完全未接受手术干预的患者率9.5%）从2002年的近40%降至2007年至2009年期间的24.5%。综合所有患者（有治愈和姑息意向），多模式治疗启用后，4年生存概率从40.0%提高到了48.5%。在2007年至2009年的调查期内，对所有研究对象进行5年随访后，中位生存时间为34个月。接受姑息性手术干预的患者从术后姑息化疗中获益；然而，正如预期的那样，这对接受切除性手术干预的患者比对非切除性手术的患者益处更大。在围手术期风险可接受的情况下，姑息性肿瘤切除（即使是R2切除状态）应成为多模式姑息治疗概念的一部分。
