Parry K, van Rossum P S N, Haj Mohammad N, Ruurda J P, van Hillegersberg R
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur J Surg Oncol. 2017 Jan;43(1):226-233. doi: 10.1016/j.ejso.2016.06.393. Epub 2016 Jun 29.
The optimal neoadjuvant approach for patients with adenocarcinomas of the gastroesophageal junction (GEJ) remains unclear. Aim of this study was to evaluate the usefulness of perioperative chemotherapy in these patients.
Consecutive patients with GEJ adenocarcinoma, treated with surgery alone or chemotherapy plus surgery, were included from a prospective database (2003-2013). Propensity score matching was used to build comparable groups. Response to chemotherapy was assessed according to standardized regression grading.
After propensity score matching, 196 patients were included. Chemotherapy was administered in 124 patients (63%). There was no difference between the chemotherapy plus surgery and surgery-alone group regarding overall and disease-free survival (p = 0.351 and p = 0.529). Pathological good response (i.e. tumor regression grading [TRG] 1-3) was achieved in 32 patients (34%), whereas 81 (66%) had poor response (TRG 4). Good responders had lower ypT-stage (p < 0.001), lower ypN-stage (p < 0.001) and more R0-resections (100% vs. 78%, p = 0.016) compared to surgery-alone patients, which improved the 5-year survival from 35% to 67% (p = 0.002). They also developed less recurrences (35% vs. 57%, p = 0.048). In poor responders, histopathology did not differ compared to surgery-alone and more recurrences were found (73% vs. 57%, p = 0.037). Overall survival in poor responders was 21% compared to 35% in surgery-alone patients (p = 0.551).
Perioperative chemotherapy for GEJ adenocarcinoma leads to increased survival in good responders (34%) as compared to surgery alone. Poor responders had no survival benefit and developed more recurrences, which underlines the importance of the search for predictive biological or radiological markers to predict or assess chemotherapy sensitivity.
胃食管交界腺癌（GEJ）患者的最佳新辅助治疗方法仍不明确。本研究旨在评估围手术期化疗对这些患者的有效性。
从一个前瞻性数据库（2003 - 2013年）中纳入连续接受单纯手术或化疗加手术治疗的GEJ腺癌患者。采用倾向评分匹配法构建可比组。根据标准化回归分级评估化疗反应。
倾向评分匹配后，纳入196例患者。124例患者（63%）接受了化疗。化疗加手术组与单纯手术组在总生存期和无病生存期方面无差异（p = 0.351和p = 0.529）。32例患者（34%）达到病理良好反应（即肿瘤退缩分级[TRG] 1 - 3），而81例（66%）反应较差（TRG 4）。与单纯手术患者相比，良好反应者的ypT分期更低（p < 0.001），ypN分期更低（p < 0.001），R0切除率更高（100%对78%，p = 0.016），5年生存率从35%提高到67%（p = 0.002）。他们的复发率也更低（35%对57%，p = 0.048）。在反应较差者中，组织病理学与单纯手术患者相比无差异，且复发更多（73%对57%，p = 0.037）。反应较差者的总生存期为21%，而单纯手术患者为35%（p = 0.551）。
与单纯手术相比，GEJ腺癌围手术期化疗可使良好反应者（34%）的生存期延长。反应较差者无生存获益且复发更多，这凸显了寻找预测性生物学或放射学标志物以预测或评估化疗敏感性的重要性。
