Jabo Brice, Selleck Matthew J, Morgan John W, Lum Sharon S, Bahjri Khaled A, Aljehani Mayada, Garberoglio Carlos A, Reeves Mark E, Namm Jukes P, Solomon Naveenraj L, Luca Fabrizio, Dyke Crickett, Senthil Maheswari
School of Public Health, Loma Linda University, Loma Linda, CA, USA.
Division of Surgical Oncology, Loma Linda University, Loma Linda, CA, USA.
J Gastrointest Oncol. 2018 Feb;9(1):35-45. doi: 10.21037/jgo.2017.10.13.
Both perioperative chemotherapy (PC) and adjuvant chemoradiotherapy (CRT) improve survival in resectable gastric cancer; however, these treatments have never been formally compared. Our objective was to evaluate treatment trends and compare survival outcomes for gastric cancer patients treated with surgery and either PC or CRT.
We performed a retrospective population-based cohort study between 2007 through 2013 using California Cancer Registry data. Patients diagnosed with stage IB-III gastric adenocarcinoma and treated with total or partial gastrectomy were eligible for this study. Based on the type of treatment received, patients were grouped into surgery-only, PC, or CRT. Primary and secondary outcomes were overall survival (OS) and gastric cancer-specific survival (GCCS) respectively. Mortality hazards ratios (HRs) for each of these outcomes were computed using propensity score weighted and covariate-adjusted Cox regression models, stratified by clinical node status.
Of 2,146 patients who underwent surgical resection, 1,067 had surgery-only, while 771 and 308 received PC or CRT, respectively. Median OS was 25, 33, and 52 months for surgery-only, PC, and CRT, respectively; P<0.001. Overall, patients treated with PC had significantly poorer survival compared to CRT (HR =1.45; 95% CI: 1.22-1.73). PC was also associated with higher mortality in patients with signet ring histology (HR =1.66; 95% CI: 1.21-2.28) and clinical node negative cancer (HR =1.85; 95% CI: 1.32-2.60). Survival was not different between PC CRT in clinical node positive patients (HR =1.29; 95% CI: 0.84-2.08). Of note, the percentage of patients receiving PC increased from 17.5% in 2007-2008, to 41.5% in 2013-2014; P<0.001.
Despite the rapid adoption of PC, overall, CRT is associated with better survival than PC. Specifically, clinical node negative and signet ring histology patients had better survival when treated with CRT compared to PC. Based on these findings, we recommend against indiscriminate adoption of PC and consideration for CRT over PC in clinical node negative patients.
围手术期化疗（PC）和辅助放化疗（CRT）均可提高可切除胃癌患者的生存率；然而，这两种治疗方法从未进行过正式比较。我们的目的是评估治疗趋势，并比较接受手术联合PC或CRT治疗的胃癌患者的生存结果。
我们利用加利福尼亚癌症登记数据，于2007年至2013年进行了一项基于人群的回顾性队列研究。诊断为IB-III期胃腺癌并接受全胃或部分胃切除术的患者符合本研究条件。根据接受的治疗类型，患者被分为单纯手术组、PC组或CRT组。主要和次要结局分别为总生存期（OS）和胃癌特异性生存期（GCCS）。使用倾向评分加权和协变量调整的Cox回归模型计算这些结局的死亡风险比（HRs），并按临床淋巴结状态分层。
在2146例行手术切除的患者中，1067例仅接受手术，771例和308例分别接受PC或CRT。单纯手术组、PC组和CRT组的中位OS分别为25个月、33个月和52个月；P<0.001。总体而言，与CRT相比，接受PC治疗的患者生存率显著较差（HR =1.45；95%CI：1.22-1.73）。PC还与印戒组织学患者（HR =1.66；95%CI：1.21-2.28）和临床淋巴结阴性癌症患者（HR =1.85；95%CI：1.32-2.60）的较高死亡率相关。临床淋巴结阳性患者中，PC和CRT的生存率无差异（HR =1.29；95%CI：0.84-2.08）。值得注意的是，接受PC治疗的患者比例从2007-2008年的17.5%增加到2013-2014年的41.5%；P<0.001。
尽管PC迅速得到应用，但总体而言，CRT与比PC更好的生存率相关。具体而言，与PC相比，临床淋巴结阴性和印戒组织学患者接受CRT治疗时生存率更好。基于这些发现，我们建议不要不加选择地采用PC，并建议临床淋巴结阴性患者考虑采用CRT而非PC。
