Fitzgerald Timothy L, Efird Jimmy T, Bellamy Nelly, Russo Suzanne M, Jindal Charulata, Mosquera Catalina, Holliday Elizabeth G, Biswas Tithi
Surgical Oncology, Maine Medical Center Cancer Institute, Scarborough, Maine.
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Cancer. 2017 Aug 1;123(15):2909-2917. doi: 10.1002/cncr.30692. Epub 2017 Apr 6.
Both perioperative chemotherapy (PECT) and postoperative chemoradiotherapy (POCRT) have a significant survival advantage over surgery alone for the treatment of patients with gastric cancer. However, to the best of our knowledge, these regimens have not been compared in a randomized clinical trial. The purpose of the current observational study was to compare overall survival among patients receiving PECT versus POCRT for the treatment of gastric/gastroesophageal junction (GEJ) adenocarcinomas.
Patients with resected clinical American Joint Committee on Cancer TNM stage II or III adenocarcinomas of the stomach or GEJ from 2004 through 2013 were identified utilizing the National Cancer Data Base. Hazard ratios (HRs), 95% confidence intervals, and P values were computed using a Cox proportional hazards procedure. Multivariable models were adjusted for treatment regimen, age, race, ethnicity, tumor size, TNM stage, Charlson comorbidity index, and tumor grade.
Patients receiving PECT had a 72% survival advantage compared with those treated with POCRT (5058 patients; HR, 0.58 [adjusted P<.0001]). The 5-year actuarial survival rate for PECT was 44% compared with 38% for POCRT. A statistically significant survival advantage for PECT also was observed when the analysis was stratified by clinical stage of disease (stage II [3192 patients]: adjusted HR, 0.79 [P = .041]; and stage III [1866 patients]: adjusted HR, 0.49 [P<.0001]). This benefit was greatest among patients with lymph node-positive disease who converted to lymph node-negative status with PECT.
In this large series of patients with stage II/III resected gastric/GEJ adenocarcinomas from >1500 American College of Surgeons Commission on Cancer-accredited facilities, patients receiving PECT were shown to survive longer than those receiving POCRT. Cancer 2017;123:2909-17. © 2017 American Cancer Society.
围手术期化疗（PECT）和术后放化疗（POCRT）在治疗胃癌患者方面，相较于单纯手术均具有显著的生存优势。然而，据我们所知，这些治疗方案尚未在随机临床试验中进行比较。本观察性研究的目的是比较接受PECT与POCRT治疗胃/胃食管交界（GEJ）腺癌患者的总生存期。
利用国家癌症数据库确定2004年至2013年期间接受手术切除的美国癌症联合委员会临床TNM分期为II期或III期的胃或GEJ腺癌患者。采用Cox比例风险模型计算风险比（HRs）、95%置信区间和P值。多变量模型根据治疗方案、年龄、种族、民族、肿瘤大小、TNM分期、Charlson合并症指数和肿瘤分级进行调整。
与接受POCRT治疗的患者相比，接受PECT治疗的患者具有72%的生存优势（5058例患者；HR，0.58[校正P<0.0001]）。PECT的5年精算生存率为44%，而POCRT为38%。当按疾病临床分期进行分层分析时，PECT也观察到具有统计学意义的生存优势（II期[3192例患者]：校正HR，0.79[P = 0.041]；III期[1866例患者]：校正HR，0.49[P<0.0001]）。这种益处在通过PECT转为淋巴结阴性状态的淋巴结阳性疾病患者中最为显著。
在来自1500多家美国外科医师学会癌症委员会认可机构的这一大系列II/III期切除的胃/GEJ腺癌患者中，接受PECT治疗的患者生存期长于接受POCRT治疗的患者。《癌症》2017年；123：2909 - 17。©2017美国癌症协会。
