淋巴结阴性胃腺癌复发及生存的相关因素：美国胃癌协作组的一项七机构研究
Factors Associated With Recurrence and Survival in Lymph Node-negative Gastric Adenocarcinoma: A 7-Institution Study of the US Gastric Cancer Collaborative.
作者信息
Jin Linda X, Moses Lindsey E, Squires M Hart, Poultsides George A, Votanopoulos Konstantinos, Weber Sharon M, Bloomston Mark, Pawlik Timothy M, Hawkins William G, Linehan David C, Strasberg Steven M, Schmidt Carl, Worhunsky David J, Acher Alexandra W, Cardona Kenneth, Cho Clifford S, Kooby David A, Levine Edward, Winslow Emily R, Saunders Neil D, Spolverato Gaya, Maithel Shishir K, Fields Ryan C
机构信息
*Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO †Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA ‡Department of Surgery, Stanford University Medical Center, Stanford, CA §Department of Surgery, Wake Forest University, Winston-Salem, NC ¶Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI ||Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH **Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
Ann Surg. 2015 Dec;262(6):999-1005. doi: 10.1097/SLA.0000000000001084.
OBJECTIVES
To determine pathologic features associated with recurrence and survival in patients with lymph node-negative gastric adenocarcinoma.
STUDY DESIGN
Multi-institutional retrospective analysis.
BACKGROUND
Lymph node status is among the most important predictors of recurrence after gastrectomy for gastric adenocarcinoma. Pathologic features predictive of recurrence in patients with node-negative disease are less well established.
METHODS
Patients who underwent curative resection for gastric adenocarcinoma between 2000 and 2012 from 7 institutions of the US Gastric Cancer Collaborative were analyzed, excluding 30-day mortalities and stage IV disease. Competing risks regression and multivariate Cox regression were used to determine pathologic features associated with time to recurrence and overall survival. Differences in cumulative incidence of recurrence were assessed using the Gray method (for univariate nonparametric analyses) and the Fine and Gray method (for multivariate analyses) and shown as subhazard ratios (SHRs) and adjusted subhazard ratios (aSHRs), respectively.
RESULTS
Of 805 patients who met inclusion criteria, 317 (39%) had node-negative disease, of which 54 (17%) recurred. By 2 and 5 years, 66% and 88% of patients, respectively, experienced recurrence. On multivariate competing risks regression, only T-stage 3 or higher was associated with shorter time to recurrence [aSHR = 2.7; 95% confidence interval (CI), 1.5-5.2]. Multivariate Cox regression showed T-stage 3 or higher [hazard ratio (HR) = 1.8; 95% CI, 1.2-2.8], lymphovascular invasion (HR = 2.2; 95% CI, 1.4-3.4), and signet ring histology (HR = 2.1; 95% CI, 1.2-3.6) to be associated with decreased overall survival.
CONCLUSIONS
Despite absence of lymph node involvement, patients with T-stage 3 or higher have a significantly shorter time to recurrence. These patients may benefit from more aggressive adjuvant therapy and postoperative surveillance regimens.
目的
确定淋巴结阴性胃腺癌患者复发及生存相关的病理特征。
研究设计
多机构回顾性分析。
背景
淋巴结状态是胃腺癌胃切除术后复发的最重要预测因素之一。对于淋巴结阴性疾病患者，预测复发的病理特征尚不明确。
方法
分析2000年至2012年间美国胃癌协作组7家机构接受胃癌根治性切除术的患者，排除30天内死亡病例及IV期疾病患者。采用竞争风险回归和多变量Cox回归确定与复发时间及总生存相关的病理特征。使用Gray法（单变量非参数分析）和Fine and Gray法（多变量分析）评估复发累积发生率差异，分别表示为亚风险比（SHRs）和调整后亚风险比（aSHRs）。
结果
805例符合纳入标准的患者中，317例（39%）为淋巴结阴性疾病，其中54例（17%）复发。到2年和5年时，分别有66%和88%的患者复发。多变量竞争风险回归显示，仅T分期3期或更高与复发时间缩短相关[aSHR = 2.7；95%置信区间（CI），1.5 - 5.2]。多变量Cox回归显示，T分期3期或更高[风险比（HR）= 1.8；95% CI，1.2 - 2.8]、淋巴管侵犯（HR = 2.2；95% CI，1.4 - 3.4）和印戒组织学类型（HR = 2.1；95% CI，1.2 - 3.6）与总生存降低相关。
结论
尽管无淋巴结受累，但T分期3期或更高的患者复发时间显著缩短。这些患者可能从更积极的辅助治疗和术后监测方案中获益。
Zotero 插件