Ozden Sevgi, Ozgen Zerrin, Ozyurt Hazan, Gemici Cengiz, Yaprak Gokhan, Tepetam Huseyin, Mayadagli Alpaslan
Radiation Oncology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, 34890 Istanbul, Turkey.
Faculty of Medicine, Bezmialem Vakif University, 34093 Istanbul, Turkey.
World J Gastroenterol. 2015 Jan 28;21(4):1222-33. doi: 10.3748/wjg.v21.i4.1222.
To evaluate survival data in patients with gastric cancer in relation to postoperative adjuvant therapy and survival determinants
A total of 201 patients (mean±SD age: 56.0±11.9 years, 69.7% were males) with gastric carcinoma who were operated and followed up at Lutfi Kirdar Kartal Training and Research Hospital between 1998 and 2010 were included in this retrospective study. Follow up was evaluated divided into two consecutive periods (before 2008 and 2008-2010, respectively) based on introduction of 3-D conformal technique in radiotherapy at our clinic in 2008. Data on patient demographics, clinical and histopathological characteristics of gastric carcinoma and the type of treatment applied after surgery [postoperative adjuvant treatment protocols including chemoradiotherapy (CRT) and chemotherapy (CT), supportive therapy or follow up without any treatment] were recorded. The median duration and determinants of local recurrence free (LRF) survival, distant metastasis free (DMF) survival and overall survival were evaluated in the overall population as well as with respect to follow up years [1998-2008 (n=127) vs 2008-2010 (n=74)].
Median duration for LRF survival, DMF survival and overall survival were 31.9, 24.1 and 31.9 mo, respectively in patients with postoperative adjuvant CRT. No significant difference was noted in median duration for LRF survival, DMF survival and overall survival with respect to treatment protocols in the overall population and also with respect to followed up periods. In the overall population, CT protocols FUFA [5-fluorouracil (400 mg/m2) and leucovorin-folinic acid (FA, 20 mg/m2)] (29.9 mo) and UFT®+Antrex® [a fixed combination of the oral FU prodrug tegafur (flouroprymidine, FT, 300 mg/m2 per day) with FA (Antrex®), 15 mg tablet, two times a day] (42.5 mo) was significantly associated with longer LRF survival times than other CT protocols (P=0.036), while no difference was noted between CT protocols in terms of DMF survival and overall survival. Among patients received CRT, overall survival was significantly longer in patients with negative than positive surgical margin (27.7 mo vs 22.4 mo, P=0.016) in the overall study population, while time of radiotherapy initiation had no significant impact on survival times. Nodal stage was determined to be independent predictor of LRF survival in the overall study population with 4.959 fold (P=0.042) increase in mortality in patients with nodal stage N2 compared to patients with nodal stage N0, and independent predictor of overall survival with 5.132 fold (P=0.006), 5.263 fold (P=0.027) and 4.056 fold (P=0.009) increase in the mortality in patients with nodal stage N3a (before 2008), N3b (before 2008) and N2 (overall study population) when compared to patients with N0 stage, respectively.
Our findings emphasize the likelihood of postoperative adjuvant CRT to have a survival benefit in patients with resectable gastric carcinoma.
评估胃癌患者的生存数据与术后辅助治疗及生存决定因素的关系
本回顾性研究纳入了1998年至2010年间在卢特菲·基尔达尔·卡尔塔尔培训与研究医院接受手术并随访的201例胃癌患者（平均±标准差年龄：56.0±11.9岁，69.7%为男性）。根据2008年我院放疗中引入三维适形技术，将随访评估分为两个连续时期（分别为2008年之前和2008 - 2010年）。记录患者人口统计学数据、胃癌的临床和组织病理学特征以及术后应用的治疗类型[术后辅助治疗方案包括放化疗（CRT）和化疗（CT）、支持治疗或未进行任何治疗的随访]。评估总体人群以及随访年份[1998 - 2008年（n = 127）与2008 - 2010年（n = 74）]的局部无复发生存期（LRF）、远处无转移生存期（DMF）和总生存期的中位数及决定因素。
术后辅助CRT患者的LRF生存期、DMF生存期和总生存期的中位数分别为31.9个月、24.1个月和31.9个月。总体人群中，就治疗方案以及随访时期而言，LRF生存期、DMF生存期和总生存期的中位数均无显著差异。在总体人群中，CT方案FUFA[5 - 氟尿嘧啶（400 mg/m²）和亚叶酸钙（FA，20 mg/m²）]（29.9个月）和优福定® + 安曲希®[口服氟尿嘧啶前体药物替加氟（氟嘧啶，FT，每天300 mg/m²）与FA（安曲希®）的固定组合，15 mg片剂，每日两次]（42.5个月）与其他CT方案相比，显著延长了LRF生存时间（P = 0.036），而在DMF生存期和总生存期方面，各CT方案之间无差异。在接受CRT的患者中，总体研究人群中手术切缘阴性患者的总生存期显著长于手术切缘阳性患者（27.7个月对22.4个月，P = 0.016），而放疗开始时间对生存时间无显著影响。在总体研究人群中，淋巴结分期被确定为LRF生存期的独立预测因素，与N0期患者相比，N2期患者的死亡率增加4.959倍（P = 0.042）；与N0期患者相比，N3a期（2008年之前）、N3b期（2008年之前）和N2期（总体研究人群）患者的死亡率分别增加5.132倍（P = 0.006）、5.263倍（P = 0.027）和4.056倍（P = 0.009），是总生存期的独立预测因素。
我们的研究结果强调了术后辅助CRT对可切除胃癌患者有生存获益的可能性。
