接受根治性手术治疗的胃癌或胃食管交界癌新辅助化疗后病理完全缓解与生存的相关性：一项荟萃分析。

Correlation of pathological complete response with survival after neoadjuvant chemotherapy in gastric or gastroesophageal junction cancer treated with radical surgery: A meta-analysis.

作者信息

Li Ziyu, Shan Fei, Wang Yinkui, Zhang Yan, Zhang Lianhai, Li Shuangxi, Jia Yongning, Xue Kan, Miao Rulin, Li Zhemin, Ji Jiafu

机构信息

Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, China.

出版信息

PLoS One. 2018 Jan 25;13(1):e0189294. doi: 10.1371/journal.pone.0189294. eCollection 2018.

BACKGROUND

Neoadjuvant chemotherapy before radical gastrectomy is preferred for locally advanced gastric cancer. To avoid the problematic use of pTNM for patients after neoadjuvant chemotherapy, the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) gastric cancer TNM staging system (8th edition) added ypTNM for the first time. But patients achieving pathological complete response were not covered by the new ypTNM staging system. To investigate whether pathological complete response is associated with better outcome in gastric cancer, as was reported in rectal, breast and bladder cancer.

METHODS

We systematically searched the databases of PubMed, EMBASE, Web of Science and Cochrane Collaboration's Central register of controlled trials from January 1988 to April 2015 for publications which reported outcomes of patients with and without pathological complete response (pCR) (pT0N0M0) to investigate whether pCR after neoadjuvant chemotherapy in gastric or gastroesophageal junction (GEJ) treated with radical surgery is associated with better survival. The primary outcome was overall survival (OS). The secondary outcome was disease-free survival (DFS). Both were measured with a relative risk (RR). A meta-analysis was performed using the fixed effects model. Forest plots and the Q test was used to evaluate overall heterogeneity for OS and DFS.

RESULTS

A total of seven trials, 1143 patients were included and analyzed after neoadjuvant chemotherapy and radical surgery with no other preoperative treatment. The average rate of pCR was 6.74% (range: 3%-15%). The RR of patients who achieved pCR in the primary tumor and lymph nodes is 0.5 (95% confidence interval [CI], 0.25-0.98; p = 0.04), 0.34 (95% CI, 0.21-0.55; p<0.0001) and 0.44 (95% CI, 0.30-0.63; p<0.0001) for one-year-OS, three-year-OS and five-year-OS, respectively. The summary RR for three-year-DFS was 0.43 (95% CI, 0.25-0.72; p = 0.002).

CONCLUSION

Patients with resectable gastric or GEJ cancer who achieved pCR after neoadjuvant chemotherapy can gain a better outcome than patients without pCR.

背景

对于局部晚期胃癌，根治性胃切除术前行新辅助化疗是首选治疗方式。为避免新辅助化疗后患者使用pTNM分期存在问题，国际癌症控制联盟（UICC）和美国癌症联合委员会（AJCC）的胃癌TNM分期系统（第8版）首次增加了ypTNM分期。但新的ypTNM分期系统未涵盖达到病理完全缓解的患者。为研究病理完全缓解是否如在直肠癌、乳腺癌和膀胱癌中报道的那样与胃癌更好的预后相关。

方法

我们系统检索了1988年1月至2015年4月期间PubMed、EMBASE、Web of Science和Cochrane协作网对照试验中央注册库的数据库，以查找报告有或无病理完全缓解（pCR）（pT0N0M0）患者结局的文献，从而研究接受根治性手术治疗的胃癌或胃食管交界（GEJ）癌新辅助化疗后pCR是否与更好的生存率相关。主要结局为总生存期（OS）。次要结局为无病生存期（DFS）。两者均采用相对危险度（RR）进行测量。使用固定效应模型进行荟萃分析。森林图和Q检验用于评估OS和DFS的总体异质性。

结果

共有7项试验，1143例患者在接受新辅助化疗和根治性手术后纳入分析，术前未接受其他治疗。pCR的平均发生率为6.74%（范围：3%-15%）。原发肿瘤和淋巴结达到pCR的患者，1年总生存率、3年总生存率和5年总生存率的RR分别为0.5（95%置信区间[CI]，0.25-0.98；p = 0.04）、0.34（95%CI，0.21-0.55；p<0.0001）和0.44（95%CI，0.30-0.63；p<0.0001）。三年无病生存率的汇总RR为0.43（95%CI，0.25-至0.72；p = 0.002）。