Department of Radiation Oncology, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, Colorado.
Department of Radiation Oncology, University of Illinois at Chicago School of Medicine, Chicago, Illinois.
Cancer. 2017 Sep 1;123(17):3402-3409. doi: 10.1002/cncr.30748. Epub 2017 May 17.
For patients with resectable gastric adenocarcinoma, perioperative chemotherapy and adjuvant chemoradiotherapy (CRT) are considered standard options. In the current study, the authors used the National Cancer Data Base to compare overall survival (OS) between these regimens.
Patients who underwent gastrectomy for nonmetastatic gastric adenocarcinoma from 2004 through 2012 were divided into those treated with perioperative chemotherapy without RT versus those treated with adjuvant CRT. Survival was estimated and compared using univariate and multivariate models adjusted for patient and tumor characteristics, surgical margin status, and the number of lymph nodes examined. Subset analyses were performed for factors chosen a priori, and potential interactions between treatment and covariates were assessed.
A total of 3656 eligible patients were identified, 52% of whom underwent perioperative chemotherapy and 48% of whom received postoperative CRT. The median follow-up was 47 months, and the median age of the patients was 62 years. Analysis of the entire cohort demonstrated improved OS with adjuvant RT on both univariate (median of 51 months vs 42 months; P = .013) and multivariate (hazard ratio, 0.874; 95% confidence interval, 0.790-0.967 [P = .009]) analyses. Propensity score-matched analysis also demonstrated improved OS with adjuvant RT (median of 49 months vs 39 months; P = .033). On subset analysis, a significant interaction was observed between the survival impact of adjuvant RT and surgical margins, with a greater benefit of RT noted among patients with surgical margin-positive disease (hazard ratio with RT: 0.650 vs 0.952; P for interaction <.001).
In this National Cancer Data Base analysis, the use of adjuvant RT in addition to chemotherapy was associated with a significant OS advantage for patients with resected gastric cancer. The survival advantage observed with adjuvant CRT was most pronounced among patients with positive surgical margins. Cancer 2017;123:3402-9. © 2017 American Cancer Society.
对于可切除的胃腺癌患者，围手术期化疗和辅助放化疗（CRT）被认为是标准治疗方案。在本研究中，作者使用国家癌症数据库比较了这些方案的总生存率（OS）。
将 2004 年至 2012 年间接受胃切除术治疗非转移性胃腺癌的患者分为接受无放疗围手术期化疗与接受辅助 CRT 的患者。使用单变量和多变量模型估计和比较生存情况，模型调整了患者和肿瘤特征、手术切缘状态以及检查的淋巴结数量。进行了预先选择因素的亚组分析，并评估了治疗与协变量之间的潜在相互作用。
共纳入 3656 名符合条件的患者，其中 52%接受围手术期化疗，48%接受术后 CRT。中位随访时间为 47 个月，患者中位年龄为 62 岁。分析整个队列表明，辅助放疗可改善 OS，单变量分析（中位值为 51 个月比 42 个月；P=0.013）和多变量分析（风险比为 0.874；95%置信区间为 0.790-0.967[P=0.009]）。倾向评分匹配分析也显示辅助 CRT 可改善 OS（中位值为 49 个月比 39 个月；P=0.033）。在亚组分析中，观察到辅助 RT 对生存的影响与手术切缘之间存在显著的交互作用，在手术切缘阳性疾病患者中 RT 的获益更大（RT 时的风险比：0.650 比 0.952；P＜0.001）。
在这项国家癌症数据库分析中，在化疗的基础上加用辅助 RT 可显著改善接受胃切除术的胃癌患者的 OS。辅助 CRT 的生存优势在手术切缘阳性的患者中最为显著。癌症 2017；123：3402-9。©2017 美国癌症协会。
