局部进展期胃癌D2根治术及辅助放化疗后的生存结局与失败模式：一项回顾性研究
Survival outcomes and patterns of failure after D2 dissection and adjuvant chemoradiotherapy for locally advanced gastric cancer: a retrospective study.
作者信息
Yang Wang, Hu Ran, Li Gui-Chao, Zhou Meng-Long, Wang Yan, Shen Li-Jun, Liang Li-Ping, Zhang Zhen
机构信息
1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , China.
2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , China.
出版信息
Br J Radiol. 2018 Sep;91(1089):20170594. doi: 10.1259/bjr.20170594. Epub 2018 Jul 27.
OBJECTIVE
The goal of the study was to analyze the incidence and patterns of failure in patients with gastric cancer who received D2 dissection and adjuvant chemoradiotherapy (CRT).
METHODS
From January 2004 to October 2015, 324 patients with gastric cancer who underwent radical D2 resection followed by postoperative CRT were enrolled. Clinicopathological characteristics and patterns of failure were retrospectively reviewed to identify factors associated with survival and recurrence.
RESULTS
After a median follow-up of 30 months, the 3-year overall survival and 3-year disease-free survival rates of these patients were 60.3 and 51.1%, respectively. 117 patients had recurrence or metastasis, with peritoneal recurrence as the most frequent (20.7%), followed by distant metastasis (14.2%). The most commonly involved distant organs were the liver (5.9%) and bone (4.9%). Locoregional failure occurred in 39 patients (12.0%), with isolated regional failure occurring in only 23 (7.1%). Further multivariate Cox regression analysis revealed N stage to be an independent risk factor for distant failure-free survival (p = 0.012). Independent risk factors for peritoneal metastasis were tumor differentiation (p = 0.022), T stage (p =0.035) and vascular invasion (p = 0.016).
CONCLUSION
Postoperative CRT has a potential effect on optimizing locoregional control, resulting in only 12.0% of locoregional failure. In patients after D2 resection and adjuvant CRT, peritoneal metastasis was the leading pattern of failure, followed by distant metastasis. Advances in knowledge: Peritoneal recurrence was the most common pattern of failure after D2 dissection and adjuvant CRT, followed by distant metastasis, whereas locoregional relapse was relatively rare. Selection of patients based on the predicted risk of each recurrence pattern may be a reasonable approach to the optimization of treatment strategies.
目的
本研究旨在分析接受D2根治术及辅助放化疗（CRT）的胃癌患者的失败发生率及模式。
方法
纳入2004年1月至2015年10月期间324例行根治性D2切除术并术后接受CRT的胃癌患者。回顾性分析其临床病理特征及失败模式，以确定与生存和复发相关的因素。
结果
中位随访30个月后，这些患者的3年总生存率和3年无病生存率分别为60.3%和51.1%。117例患者出现复发或转移，其中腹膜复发最为常见（20.7%），其次为远处转移（14.2%）。最常累及的远处器官是肝脏（5.9%）和骨（4.9%）。39例患者发生局部区域失败（12.0%），仅23例（7.1%）为孤立区域失败。进一步多因素Cox回归分析显示，N分期是远处无失败生存的独立危险因素（p = 0.012）。腹膜转移的独立危险因素为肿瘤分化程度（p = 0.022）、T分期（p = 0.035）和血管侵犯（p = 0.016）。
结论
术后CRT对优化局部区域控制有潜在作用，局部区域失败率仅为12.0%。在接受D2切除及辅助CRT的患者中，腹膜转移是主要的失败模式，其次为远处转移。知识进展：腹膜复发是D2根治术及辅助CRT后最常见的失败模式，其次为远处转移，而局部区域复发相对少见。根据每种复发模式的预测风险选择患者可能是优化治疗策略的合理方法。
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