Badgwell Brian, Blum Mariela, Elimova Elena, Estrella Jeannelyn, Chiang Yi-Ju, Das Prajnan, Mansfield Paul, Ajani Jaffer
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2016 Jun;23(6):1948-55. doi: 10.1245/s10434-016-5112-8. Epub 2016 Feb 11.
The purpose of this study was to determine differences in stage and resection rates for patients with gastric adenocarcinoma managed with upfront surgery, preoperative chemotherapy, or preoperative chemoradiation therapy .
The medical records of 8382 patients with gastric or gastroesophageal cancer treated from January 1995 to November 2014 were reviewed. Chi square and logistic regression analysis was used to identify differences in treatment groups and variables associated with resection.
Of 533 patients evaluated for gastrectomy, 174 patients underwent upfront surgery, 90 underwent preoperative chemotherapy, and 269 underwent preoperative chemoradiation therapy. Patients treated with preoperative therapy had more advanced endoscopic ultrasound and computed tomography imaging findings. Preoperative treatment was completed in 81 % of patients administered chemotherapy and 93 % of patients administered chemoradiation. Progressive, unresectable, or metastatic disease was identified in 27 % of preoperative chemotherapy and 26 % of chemoradiation patients. Toxicity or worsening comorbidities associated with an inability to undergo resection were identified in 2 % of chemotherapy patients and 6 % of chemoradiation patients. Potentially curative resection was performed in 92, 71, and 64 % of patients treated with upfront surgery, preoperative chemotherapy, and preoperative chemoradiation, respectively. For patients treated with chemoradiation, the absence of regional lymphadenopathy on imaging was the only pretreatment variable associated with resection (odds ratio 1.77, 95 % confidence interval 1.04-3.03; p = 0.04).
Patients treated with preoperative therapy often have more advanced disease prior to treatment initiation and therefore potential for disease progression. However, toxicity that prevents resection is rare, which is an important consideration in selecting preoperative treatment.
本研究旨在确定接受 upfront 手术、术前化疗或术前放化疗的胃腺癌患者在分期和切除率方面的差异。
回顾了 1995 年 1 月至 2014 年 11 月期间接受治疗的 8382 例胃癌或胃食管癌患者的病历。采用卡方检验和逻辑回归分析来确定治疗组之间的差异以及与切除相关的变量。
在 533 例接受胃切除术评估的患者中，174 例接受 upfront 手术，90 例接受术前化疗，269 例接受术前放化疗。接受术前治疗的患者内镜超声和计算机断层扫描成像结果更晚期。化疗患者中 81%完成了术前治疗，放化疗患者中 93%完成了术前治疗。术前化疗患者中有 27%以及放化疗患者中有 26%被发现有疾病进展、无法切除或转移。化疗患者中有 2%以及放化疗患者中有 6%被发现存在与无法进行切除相关的毒性反应或合并症恶化。接受 upfront 手术、术前化疗和术前放化疗的患者中，分别有 92%、71%和 64%进行了潜在根治性切除。对于接受放化疗的患者，影像学上无区域淋巴结肿大是与切除相关的唯一预处理变量（比值比 1.77，95%置信区间 1.04 - 3.03；p = 0.04）。
接受术前治疗的患者在开始治疗前通常疾病更晚期，因此有疾病进展的可能性。然而，阻止切除的毒性反应很少见，这是选择术前治疗时的一个重要考虑因素。
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