Departments of Registry and Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.
Department of Radiotherapy, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, The Netherlands.
Ann Surg Oncol. 2017 Nov;24(12):3647-3657. doi: 10.1245/s10434-017-6048-3. Epub 2017 Aug 22.
While the curative approach to gastric cancer includes perioperative regimens in several countries, a substantial proportion of patients may not receive treatment prior to surgery. This study examines the adjuvant provision of chemoradiotherapy (CRT) for non-pretreated patients with cancer of the stomach including the gastric cardia.
All surgically treated patients with primary adenocarcinoma of the stomach and gastric cardia diagnosed between January 2004-December 2013 were selected from the Netherlands Cancer Registry. Patients who did not receive neoadjuvant treatment were included. Early gastric cancers (cT1), postoperative deaths within 90 days, patients with metastatic disease (M1), patients who received adjuvant chemotherapy and patients with macroscopic tumor after surgery (R2) were excluded.
Some 3277 patients underwent surgery, and 99 patients (3%) received adjuvant CRT. Treatment was more often administered in patients with a younger age (<65 years) and a high socioeconomic status (SES), in case of non-cardia cancer, positive lymph nodes, and positive resection margins (R1). Median survival time was 28 months (95% CI 17-39), compared to 35 months (95% CI 33-38) in CRT-naïve patients. After adjustment for confounders, a small net benefit for adjuvant CRT was found (hazard ratio, HR: 0.75, 95% CI 0.58-0.96). In subgroup analyses, benefit was most pronounced for patients with seven or more lymph metastases.
Marginal survival benefit was observed for adjuvant CRT in gastric cancer patients who did not receive neoadjuvant treatment. Treatment could be considered for patients with disease involving nodal invasion and those left with microscopic residual disease after surgery.
虽然围手术期方案在多个国家被用于治疗胃癌，但仍有相当一部分患者在手术前未接受治疗。本研究调查了未接受新辅助治疗的胃腺癌（包括贲门癌）患者接受放化疗辅助治疗的情况。
从荷兰癌症登记处选择了 2004 年 1 月至 2013 年 12 月期间接受手术治疗的原发性胃腺癌和贲门腺癌患者。纳入未接受新辅助治疗的患者。排除了早期胃癌（cT1）、术后 90 天内死亡、转移性疾病（M1）、接受辅助化疗和术后有肉眼肿瘤残留（R2）的患者。
共有 3277 例患者接受了手术，99 例（3%）患者接受了辅助 CRT 治疗。在年龄（<65 岁）较小和社会经济地位（SES）较高的患者、非贲门癌、淋巴结阳性和阳性切缘（R1）的患者中，更常进行 CRT 治疗。中位生存时间为 28 个月（95%CI 17-39），而 CRT 未治疗患者为 35 个月（95%CI 33-38）。调整混杂因素后，发现辅助 CRT 有轻微的净获益（风险比，HR：0.75，95%CI 0.58-0.96）。亚组分析显示，淋巴结转移数≥7 个的患者获益最明显。
对于未接受新辅助治疗的胃癌患者，辅助 CRT 可获得生存获益。对于有淋巴结侵犯的患者以及术后有显微镜下残留疾病的患者，可以考虑进行辅助治疗。
