Shin Hyun Beak, Lee Seung Hyoung, Son Young Gil, Ryu Seung Wan, Sohn Soo Sang
Department of Surgery, Keimyung University School of Medicine, 194, Dongsan-dong, Choong-gu, Daegu, 700-712, Korea.
World J Surg Oncol. 2015 Jan 30;13:13. doi: 10.1186/s12957-015-0447-3.
M1 gastric cancer has a poor oncologic outcome with a median survival of less than 1 year despite aggressive chemotherapy. Recent trials include chemotherapy combined non-curative gastrectomy. This study evaluated the chemoresponse after non-curative gastrectomy in M1 gastric cancer and the survival benefit.
Between January 2000 and December 2010, 660 patients received chemotherapy for gastric cancer at the Department of Hemato-Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. Data was collected retrospectively from the medical records. Patients who received preoperative or adjuvant chemotherapy, who underwent other surgeries like gastrojejunal bypass or exploratory laparotomy, who died within 3 months due to seriously advanced gastric cancer, who were lost to follow-up, or whose medical records were unsuitable for data collection were excluded. The remaining 101 patients had received chemotherapy only (CTx group, n = 76) or chemotherapy after non-curative gastrectomy (NCG + CTx group, n = 25). Clinicopathologic characteristics, chemoresponse, and overall survival were compared between the two groups.
There were no significant differences between the two groups in clinicopathologic characteristics including age, sex, body mass index (BMI), comorbidity, histologic differentiation, tumor location, clinical T stage, and initial site of distant metastasis. Chemoresponse was checked on two separate occasions from the initiation of chemotherapy: first chemotherapy regimen and until the third regimen change. The NCG + CTx group showed more favorable chemoresponse than the CTx group in both checks (60% and 72% vs. 18.4% and 23.7%). The NCG + CTx group showed longer overall survival than the CTx group (26 vs. 11 months).
Non-curative gastrectomy in M1 gastric cancer could improve chemoresponse and extend overall survival.
尽管进行了积极的化疗，M1期胃癌的肿瘤学预后仍较差，中位生存期不足1年。近期的试验包括化疗联合非根治性胃切除术。本研究评估了M1期胃癌非根治性胃切除术后的化疗反应及生存获益情况。
2000年1月至2010年12月期间，韩国大邱启明大学医学院东山医疗中心血液肿瘤科有660例患者接受了胃癌化疗。数据从病历中回顾性收集。排除接受术前或辅助化疗、接受诸如胃肠吻合术或剖腹探查术等其他手术、因严重进展期胃癌在3个月内死亡、失访或病历不适合数据收集的患者。其余101例患者仅接受了化疗（CTx组，n = 76）或非根治性胃切除术后接受了化疗（NCG + CTx组，n = 25）。比较两组的临床病理特征、化疗反应和总生存期。
两组在年龄、性别、体重指数（BMI）、合并症、组织学分化、肿瘤部位、临床T分期和远处转移初始部位等临床病理特征方面无显著差异。从化疗开始起在两个不同时间点检查化疗反应：第一个化疗方案以及直至第三个方案变更。在两次检查中，NCG + CTx组均显示出比CTx组更有利的化疗反应（分别为60%和72% vs. 18.4%和23.7%）。NCG + CTx组的总生存期比CTx组长（26个月 vs. 11个月）。
M1期胃癌的非根治性胃切除术可改善化疗反应并延长总生存期。
