Zhou Meng-Long, Li Gui-Chao, Yang Wang, Deng Wei-Juan, Hu Ran, Wang Yan, Long Zi-Wen, Liu Xiao-Wen, Wang Ya-Nong, Zhang Zhen
1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.
2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China.
Br J Radiol. 2018 Sep;91(1089):20180276. doi: 10.1259/bjr.20180276. Epub 2018 Jun 27.
The aim of this study was to compare the effects of adjuvant chemoradiotherapy (CRT) and adjuvant chemotherapy (ChT) on the survival of locally advanced gastric cancer (LAGC) patients treated with R1 resection.
The patients with LAGC and microscopically positive margins after a potentially curative gastrectomy in Fudan University Shanghai Cancer Centre were retrospectively identified. The patients who were referred to our hospital for adjuvant CRT after an R1 resection elsewhere were also included. The patients were divided into either the CRT group or ChT group according to the treatment strategy. We, then, examined the patient survival results and patterns of recurrence for each group.
There were 114 LAGC patients treated with an R1 resection identified (CRT, n = 33; ChT, n = 81). The baseline characteristics between the two groups were not different. The estimated 3 year recurrence-free survival and overall survival in the CRT and ChT groups were 45.1% vs 31.8% (p = 0.09) and 49.6% vs 39.4% (p = 0.20), respectively. The results indicated that only nodal status was an independent prognostic factor (hazard ratio 4.04, 95% confidence interval 2.06-7.93). The risk of locoregional recurrence was increased in the ChT group. The subgroup analysis revealed that patients with pN0-2 GC showed a better recurrence-free survival due to adjuvant CRT (hazard ratio 0.19, 95% confidence interval 0.04-0.90; p = 0.022).
Adjuvant CRT improves locoregional control and may benefit patients with pN0-2 GC after R1 resection. The nodal status may be the most important predictor for patient selection. Advances in knowledge: Nodal status may be the most important predictor for patient selection. Compared with adjuvant ChT, LAGC patients with pN0-2 disease may further benefit from additional radiotherapy after R1 resection.
本研究旨在比较辅助放化疗（CRT）和辅助化疗（ChT）对接受R1切除的局部进展期胃癌（LAGC）患者生存的影响。
回顾性确定复旦大学附属肿瘤医院接受潜在根治性胃切除术后切缘镜下阳性的LAGC患者。其他医院R1切除术后转诊至我院接受辅助CRT的患者也纳入研究。根据治疗策略将患者分为CRT组或ChT组。然后，我们检查了每组患者的生存结果和复发模式。
共确定114例接受R1切除的LAGC患者（CRT组，n = 33；ChT组，n = 81）。两组之间的基线特征无差异。CRT组和ChT组的3年无复发生存率和总生存率估计分别为45.1%对31.8%（p = 0.09）和49.6%对39.4%（p = 0.20）。结果表明，仅淋巴结状态是独立的预后因素（风险比4.04，95%置信区间2.06 - 7.93）。ChT组局部区域复发风险增加。亚组分析显示，pN0 - 2期胃癌患者接受辅助CRT后无复发生存率更佳（风险比0.19，95%置信区间0.04 - 0.90；p = 0.022）。
辅助CRT可改善局部区域控制，可能使R1切除术后的pN0 - 2期胃癌患者受益。淋巴结状态可能是患者选择的最重要预测指标。知识进展：淋巴结状态可能是患者选择的最重要预测指标。与辅助ChT相比，pN0 - 2期疾病的LAGC患者在R1切除术后可能从额外放疗中进一步获益。
