辅助放化疗对胃腺癌的益处：一项监测、流行病学和最终结果（SEER）人群分析
Benefit of Adjuvant Chemoradiotherapy for Gastric Adenocarcinoma: A SEER Population Analysis.
作者信息
Seyedin Steven, Wang Pin-Chieh, Zhang Quan, Lee Percy
机构信息
Department of Radiation Oncology David Geffen School of Medicine at UCLA Los Angeles, CA.
出版信息
Gastrointest Cancer Res. 2014 May;7(3-4):82-90.
BACKGROUND
Despite results of the Intergroup 0116 (INT-0116) study showing an overall survival benefit of adjuvant chemoradiotherapy in gastric adenocarcinoma, its use in the United States remains controversial. The Surveillance Epidemiology of End Results (SEER) database was used to compare cause-specific survival outcomes in resected gastric adenocarcinoma with various adjuvant therapies and patterns of care.
METHODS
Individual data from 1988 to 2008 were selected for patients with resected, nonmetastatic gastric adenocarcinoma. These patients were stratified by stage (American Joint Committee on Cancer [AJCC], 6th edition), as well as treatment modalities (surgery alone, S; surgery followed by radiotherapy, SR; surgery with chemotherapy, SC; surgery followed by radiotherapy with chemotherapy, SRC; and radiotherapy followed by surgery with chemotherapy, RSC). Overall 21,472 patients (8335 stages IA and 1B; 5944 stage II, 4594 stage III, and 2599 stage IV) were included in this study.
RESULTS
The median age of the cohort was 66 years, with 63.0% male and 66.4% white. The median number of lymph nodes examined was 17.6. Median survival by stage was 96 months for stage I, 30 months for stage II, 20 months for stage III, and 14 months for stage IV. Using the SRC group as the reference group, for stage I patients, S had the most favorable cause-specific survival (hazard ratio [HR], 0.67; confidence interval, [CI] 0.60-0.76). For patients with stage II, III, or IV, those treated with SRC had the best outcome compared with the other treatment modalities. After 1999, the number of patients treated with surgery alone decreased by at least 14%, whereas the number treated with SRC increased by approximately 12%.
CONCLUSIONS
This large SEER database analysis showed that stage I patients benefited most from surgery alone, whereas those at more advanced stages benefited most from adjuvant radiotherapy with chemotherapy. This result is consistent with INT-0116 for gastric adenocarcinoma in support of trimodality therapy and is reflected by the increased fraction of patients receiving chemotherapy and adjuvant radiation.
背景
尽管肿瘤协作组0116（INT-0116）研究结果显示辅助放化疗对胃腺癌患者的总生存有益，但在美国其应用仍存在争议。本研究利用监测、流行病学和最终结果（SEER）数据库比较接受不同辅助治疗及治疗模式的胃腺癌切除患者的病因特异性生存结局。
方法
选取1988年至2008年接受胃腺癌切除且无转移患者的个体数据。这些患者按分期（美国癌症联合委员会[AJCC]第6版）及治疗方式进行分层（单纯手术，S；手术后放疗，SR；手术联合化疗，SC；手术后放化疗，SRC；放疗后手术联合化疗，RSC）。本研究共纳入21472例患者（8335例IA期和IB期；5944例II期，4594例III期，2599例IV期）。
结果
该队列患者的中位年龄为66岁，男性占63.0%，白人占66.4%。检查的淋巴结中位数为17.6个。各分期的中位生存期分别为：I期96个月，II期30个月，III期20个月，IV期14个月。以SRC组作为参照组，I期患者中，单纯手术的病因特异性生存最有利（风险比[HR]，0.67；可信区间，[CI] 0.60 - 0.76）。对于II期、III期或IV期患者，与其他治疗方式相比，接受SRC治疗的患者结局最佳。1999年后，单纯手术治疗的患者数量至少减少了14%，而接受SRC治疗的患者数量增加了约12%。
结论
这项基于SEER数据库的大型分析表明，I期患者从单纯手术中获益最大，而晚期患者从辅助放化疗中获益最大。这一结果与INT-0116研究中胃腺癌的结果一致，支持三联疗法，且接受化疗和辅助放疗的患者比例增加也反映了这一点。
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