Department of Surgery, New York University, New York, NY, USA.
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
J Gastrointest Surg. 2017 Dec;21(12):1984-1992. doi: 10.1007/s11605-017-3594-8. Epub 2017 Sep 29.
Perioperative chemotherapy in gastric cancer is increasingly used since the "MAGIC" trial, while clinical practice data outside of trials remain limited. We sought to evaluate the predictors and prognostic implications of perioperative chemotherapy completion in patients undergoing curative-intent gastrectomy across multiple US institutions.
Patients who underwent curative-intent resection of gastric adenocarcinoma between 2000 and 2012 in eight institutions of the US Gastric Cancer Collaborative were identified. Patients who received preoperative chemotherapy were included, while those who died within 90 days or with unknown adjuvant chemotherapy status were excluded. Predictors of chemotherapy completion and survival were identified using multivariable logistic regression and Cox proportional hazards.
One hundred sixty three patients were included (median age 63.3, 36.8% female). The postoperative component of perioperative chemotherapy was administered in 112 (68.7%) patients. Factors independently associated with receipt of adjuvant chemotherapy were younger age (odds ratio (OR) 2.73, P = 0.03), T3 tumors (OR 14.3, P = 0.04), lymph node metastasis (OR 5.82, P = 0.03), and D2 lymphadenectomy (OR 4.12, P = 0.007), and, inversely, postoperative complications (OR 0.25, P = 0.008). Median overall survival (OS) was 25.1 months and 5-year OS was 36.5%. Predictors of OS were preexisting cardiac disease (hazard ratio (HR) 2.7, 95% CI 1.13-6.46), concurrent splenectomy (HR 4.11, 95% CI 1.68-10.0), tumor stage (reference stage I; stage II HR 2.62; 95% CI 0.99-6.94; stage III HR 4.86, 95% CI 1.81-13.02), and D2 lymphadenectomy (HR 0.43, 95% CI 0.19-0.95). After accounting for these factors, adjuvant chemotherapy administration was associated with improved OS (HR 0.33, 95% CI 0.14-0.82).
Completion of perioperative chemotherapy was successful in two thirds of patients with gastric cancer and was independently associated with improved survival.
自“MAGIC”试验以来，胃癌的围手术期化疗越来越多地被应用，而临床试验以外的临床实践数据仍然有限。我们旨在评估多个美国机构接受根治性胃切除术的患者完成围手术期化疗的预测因素和预后意义。
在 8 个美国胃癌协作组机构中，确定了 2000 年至 2012 年间接受根治性胃腺癌切除术的患者。纳入接受术前化疗的患者，排除 90 天内死亡或辅助化疗状态未知的患者。使用多变量逻辑回归和 Cox 比例风险模型确定化疗完成和生存的预测因素。
共纳入 163 例患者（中位年龄 63.3 岁，36.8%为女性）。112 例（68.7%）患者接受了术后围手术期化疗。与接受辅助化疗相关的独立因素包括年龄较小（优势比[OR]2.73，P=0.03）、T3 肿瘤（OR 14.3，P=0.04）、淋巴结转移（OR 5.82，P=0.03）和 D2 淋巴结清扫术（OR 4.12，P=0.007），相反，术后并发症（OR 0.25，P=0.008）。中位总生存期（OS）为 25.1 个月，5 年 OS 为 36.5%。OS 的预测因素包括术前心脏病（风险比[HR]2.7，95%CI 1.13-6.46）、同时性脾切除术（HR 4.11，95%CI 1.68-10.0）、肿瘤分期（参考 I 期；II 期 HR 2.62；95%CI 0.99-6.94；III 期 HR 4.86，95%CI 1.81-13.02）和 D2 淋巴结清扫术（HR 0.43，95%CI 0.19-0.95）。在考虑这些因素后，辅助化疗的应用与 OS 改善相关（HR 0.33，95%CI 0.14-0.82）。
三分之二的胃癌患者完成了围手术期化疗，并且与生存改善独立相关。
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