放化疗对比单纯化疗作为局限性胃癌辅助治疗的疗效：倾向评分匹配分析。
Chemoradiotherapy versus chemotherapy as adjuvant treatment for localized gastric cancer: a propensity score-matched analysis.
机构信息
Department of oncology, Hospital Sírio Libanês, SGAS 613, conjunto E lote 95, Asa Sul, Brasília, DF, 70200-001, Brazil.
Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
出版信息
BMC Cancer. 2018 Apr 3;18(1):378. doi: 10.1186/s12885-018-4305-x.
BACKGROUND
Treatment of localized gastric cancer (LGC) consists of surgical resection followed by adjuvant treatment. Both chemoradiation (CRT) and chemotherapy (CT) regimens have shown benefit in survival outcomes versus observation. However, there are few data comparing these approaches.
METHODS
This study included consecutive patients with LGC treated at Instituto do Cancer do Estado de Sao Paulo (ICESP) from 2012 to 2015. CRT was based on the INT-0116 regimen and CT consisted of a platinum and fluoropyrimidine doublet. Treatment choice was based on physician preference. Toxicity was evaluated for every cycle. Overall survival (OS) analysis was performed by Kaplan-Meier. A propensity score-matched analysis was performed to minimize selection bias.
RESULTS
A total of 309 patients were evaluated, 227 in CRT group and 82 in CT group. The most prevalent grade 3/4 toxicities in CRT and CT groups were: nausea/vomiting (9.25 vs 4.9%), fatigue (9.3% vs 2.4%), mucositis (4.4% vs 1.2%), neutropenia (37.8% vs 20.9%), febrile neutropenia (3.9% vs 0%), anemia (4.3% vs 6.1%), thrombocytopenia (2.6% vs 4.9%), neuropathy (0 vs 2.4%) and hand-foot syndrome (0.4% vs 2.4%). Two grade 5 toxicities (febrile neutropenia and anemia) occurred in CRT group. There was no difference in the pattern of recurrence. After a median follow-up of 23.5 months (CRT) and 20.6 months (CT), there was no difference in OS between groups.
CONCLUSIONS
CT and CRT present similar efficacy and tolerability as adjuvant treatment for LGC.
背景
局部胃癌（LGC）的治疗包括手术切除和辅助治疗。与观察相比，放化疗（CRT）和化疗（CT）方案在生存结果方面都显示出了获益。然而，比较这些方法的相关数据很少。
方法
本研究纳入了 2012 年至 2015 年在巴西圣保罗癌症研究所（ICESP）接受治疗的连续 LGC 患者。CRT 方案基于 INT-0116 方案，CT 方案由铂类和氟嘧啶类双联药物组成。治疗方案的选择基于医生的偏好。每周期评估毒性。采用 Kaplan-Meier 法进行总生存（OS）分析。采用倾向评分匹配分析以尽量减少选择偏倚。
结果
共评估了 309 例患者，227 例患者接受 CRT 治疗，82 例患者接受 CT 治疗。在 CRT 和 CT 组中，最常见的 3/4 级毒性分别为：恶心/呕吐（9.25% vs. 4.9%）、乏力（9.3% vs. 2.4%）、黏膜炎（4.4% vs. 1.2%）、中性粒细胞减少症（37.8% vs. 20.9%）、发热性中性粒细胞减少症（3.9% vs. 0%）、贫血（4.3% vs. 6.1%）、血小板减少症（2.6% vs. 4.9%）、周围神经病变（0% vs. 2.4%）和手足综合征（0.4% vs. 2.4%）。CRT 组发生 2 例 5 级毒性（发热性中性粒细胞减少症和贫血）。复发模式无差异。在 CRT 组的中位随访 23.5 个月和 CT 组的中位随访 20.6 个月后，两组之间的 OS 无差异。
结论
CT 和 CRT 作为 LGC 的辅助治疗具有相似的疗效和耐受性。
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