Ikoma Naruhiko, Hofstetter Wayne L, Estrella Jeannelyn S, Das Prajnan, Minsky Bruce D, Fournier Keith F, Mansfield Paul F, Ajani Jaffer A, Badgwell Brian D
Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department Cardiac and Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Surg Oncol. 2018 Jun;117(8):1721-1728. doi: 10.1002/jso.25081. Epub 2018 Jun 27.
Although the eighth-edition American Joint Committee on Cancer (AJCC) gastric cancer staging system created ypTNM staging for patients who underwent preoperative therapy, the ideal ypTNM grouping is unknown. We sought to investigate risk factors for OS in ypT0-3N0M0 gastric cancer.
From an institutional database of The University of Texas MD Anderson Cancer Center and the National Cancer Database (NCDB), we identified patients with ypT0-3N0M0 gastric adenocarcinoma who underwent R0 gastrectomy after chemotherapy or chemoradiation during 1995-2015 (MD Anderson) or 2006-2014 (NCDB).
The study included 175 MD Anderson and 3200 NCDB patients. By multivariable analysis, ypT category was not associated with OS (hazard ratio [HR] for ypT3 vs ypT1: MD Anderson, 0.83 [95% CI, 0.36-1.92], P = 0.669; NCDB, 0.96 [95% CI, 0.85-1.08], P = 0.472). cN-positive disease was not associated with OS in the MD Anderson cohort (HR, 0.96 [95% CI, 0.55-1.67]; P = 0.873) but was weakly associated with shorter OS in the NCDB cohort (HR, 1.11 [95% CI, 1.01-1.21]; P = 0.031).
The ypT category does not impact OS in ypT0-3N0M0 gastric cancer. The impact of cN status on OS appeared limited. These findings should be considered in future systems of post-neoadjuvant pathologic staging.
尽管美国癌症联合委员会（AJCC）第八版胃癌分期系统为接受术前治疗的患者创建了ypTNM分期，但理想的ypTNM分组尚不清楚。我们试图研究ypT0-3N0M0期胃癌患者总生存期（OS）的危险因素。
从德克萨斯大学MD安德森癌症中心的机构数据库和国家癌症数据库（NCDB）中，我们确定了在1995 - 2015年（MD安德森）或2006 - 2014年（NCDB）期间接受化疗或放化疗后行R0胃切除术的ypT0-3N0M0期胃腺癌患者。
该研究纳入了175例MD安德森癌症中心的患者和3200例NCDB的患者。通过多变量分析，ypT分类与总生存期无关（MD安德森癌症中心，ypT3与ypT1相比的风险比[HR]为0.83[95%CI，0.36 - 1.92]，P = 0.669；NCDB，HR为0.96[95%CI，0.85 - 1.08]，P = 0.472）。在MD安德森队列中，cN阳性疾病与总生存期无关（HR，0.96[95%CI，0.55 - 1.67]；P = 0.873），但在NCDB队列中与较短的总生存期弱相关（HR，1.11[95%CI，1.01 - 1.21]；P = 0.031）。
ypT分类对ypT0-3N0M0期胃癌的总生存期没有影响。cN状态对总生存期的影响似乎有限。这些发现应在未来的新辅助治疗后病理分期系统中予以考虑。
