Badgwell Brian, Ajani Jaffer, Blum Mariela, Ho Linus, Fournier Keith, Chiang Yi-Ju, Matamoros Aurelio, Das Prajnan, Mansfield Paul
Department of Surgical Oncology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2016 Jan;23(1):156-62. doi: 10.1245/s10434-015-4643-8. Epub 2015 Jun 10.
This study aimed to determine whether postoperative morbidity and mortality rates increased after preoperative chemoradiation in patients who underwent gastrectomy.
The medical records of 7404 patients with gastric or gastroesophageal cancer seen from January 1995 to August 2012 were reviewed to identify patients who underwent gastrectomy. χ (2) and logistic regression analysis were used to determine differences in the 90-day postoperative morbidity and mortality rates of patients who underwent upfront surgery (SURG), preoperative chemotherapy (CHEMO), or preoperative chemoradiation (CHEMOXRT).
Of the 500 patients included in this study, 200 underwent SURG, 65 had CHEMO, and 235 had CHEMOXRT. Respectively, 33, 43, and 58 % of these patients underwent total gastrectomy (p < 0.01). Resection of other organs was performed respectively in 19, 26, and 23 % of the patients (p = 0.37). Minor complications within 90 days (Clavien-Dindo 1 or 2) occurred for 41 % of the SURG patients, 43 % of the CHEMO patients, and 45 % of the CHEMOXRT patients (p = 0.68). Major complications or death within 90 days (Clavien-Dindo 3, 4, or 5) occurred for 21, 28, and 29 % of the patients, respectively (p = 0.15). The 90-day mortality (Clavien-Dindo 5) rates were 2 % for the SURG patients, 6 % for the CHEMO patients, and 3 % for the CHEMOXRT patients (p = 0.25). The median hospital stays were respectively 12, 12, and 13 days (p = 0.09). In the multivariate analysis, male sex, gastroesophageal junction cancer, total gastrectomy, and resection of other organs were associated with increased major morbidity and mortality rates, whereas preoperative therapy was not.
The CHEMOXRT patients had postoperative morbidity and mortality rates similar to those for the SURG and CHEMO patients.
本研究旨在确定接受胃切除术的患者术前放化疗后术后发病率和死亡率是否增加。
回顾1995年1月至2012年8月期间7404例胃癌或胃食管癌患者的病历，以确定接受胃切除术的患者。采用χ(2)检验和逻辑回归分析来确定接受 upfront 手术（SURG）、术前化疗（CHEMO）或术前放化疗（CHEMOXRT）的患者术后90天发病率和死亡率的差异。
本研究纳入的500例患者中，200例接受SURG，65例接受CHEMO，235例接受CHEMOXRT。这些患者中分别有33%、43%和58%接受了全胃切除术（p < 0.01）。分别有19%、26%和23%的患者进行了其他器官切除（p = 0.37）。90天内轻微并发症（Clavien-Dindo 1或2级）在SURG组患者中发生率为41%，CHEMO组患者中为43%，CHEMOXRT组患者中为45%（p = 0.68）。90天内严重并发症或死亡（Clavien-Dindo 3、4或5级）在患者中的发生率分别为21%、28%和29%（p = 0.15）。90天死亡率（Clavien-Dindo 5级）在SURG组患者中为2%，CHEMO组患者中为6%，CHEMOXRT组患者中为3%（p = 0.25）。中位住院时间分别为12天、12天和13天（p = 0.09）。在多因素分析中，男性、胃食管交界癌、全胃切除术和其他器官切除与严重发病率和死亡率增加相关，而术前治疗则无关。
接受CHEMOXRT的患者术后发病率和死亡率与接受SURG和CHEMO的患者相似。
