Eom Bang Wool, Kim Sohee, Kim Ja Yeon, Yoon Hong Man, Kim Mi-Jung, Nam Byung-Ho, Kim Young-Woo, Park Young-Iee, Park Sook Ryun, Ryu Keun Won
Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Biometric Research Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Korea.
J Gastric Cancer. 2018 Mar;18(1):69-81. doi: 10.5230/jgc.2018.18.e9. Epub 2018 Mar 30.
It has been reported that the survival of patients with locally advanced gastric cancer (LAGC) is better in East Asia countries than in developed western countries; however, the prognosis of LAGC remains poor. This study aimed to evaluate the effects of perioperative chemotherapy on the long-term survival of East Asia patients with LAGC.
From October 2006 through August 2008, 43 patients with LAGC received perioperative S-1 combined with weekly docetaxel in a phase II study (neoadjuvant group). These patients were matched using propensity scores to patients who underwent surgery without neoadjuvant chemotherapy during the same period (surgery group). The surgical outcomes and long-term survivals were compared between the 2 groups.
After matching, 43 and 86 patients were included in the neoadjuvant and surgery groups, respectively, and there was no significant difference in their baseline characteristics. Although the operating time was longer in the neoadjuvant group, there was no significant difference in postoperative complications between the 2 groups. The neoadjuvant group had a significantly higher 5-year overall survival (OS) rate (73.3% vs. 51.1%, P=0.005) and a trend towards higher 5-year progression-free survival (PFS) (62.8% vs. 49.9%, P=0.145). In the multivariate analysis, perioperative chemotherapy was an independent factor for OS, with a hazard ratio of 0.4 (P=0.005) and a marginal effect on the PFS (P=0.054).
Perioperative chemotherapy was associated with better long-term survival without increasing postoperative complications in the setting of D2 surgery for patients with LAGC, suggesting that perioperative chemotherapy can be a therapeutic option in East Asia countries.
据报道，局部晚期胃癌（LAGC）患者在东亚国家的生存率高于西方发达国家；然而，LAGC的预后仍然较差。本研究旨在评估围手术期化疗对东亚LAGC患者长期生存的影响。
2006年10月至2008年8月，43例LAGC患者在一项II期研究中接受了围手术期S-1联合每周多西他赛治疗（新辅助治疗组）。这些患者使用倾向评分与同期接受手术但未进行新辅助化疗的患者进行匹配（手术组）。比较两组的手术结果和长期生存率。
匹配后，新辅助治疗组和手术组分别纳入43例和86例患者，其基线特征无显著差异。虽然新辅助治疗组的手术时间较长，但两组术后并发症无显著差异。新辅助治疗组的5年总生存率（OS）显著更高（73.3%对51.1%，P=0.005），5年无进展生存率（PFS）有升高趋势（62.8%对49.9%，P=0.145）。在多变量分析中，围手术期化疗是OS的独立因素，风险比为0.4（P=0.005），对PFS有边际效应（P=0.054）。
对于LAGC患者，在D2手术的情况下，围手术期化疗与更好的长期生存相关，且不增加术后并发症，这表明围手术期化疗可作为东亚国家的一种治疗选择。
