胃腺癌术前治疗可改善胃切除术后并发症患者的不良肿瘤学结局。
Preoperative Therapy for Gastric Adenocarcinoma is Protective for Poor Oncologic Outcomes in Patients with Complications After Gastrectomy.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1484, Houston, TX, 77030, USA.
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Ann Surg Oncol. 2018 Sep;25(9):2720-2730. doi: 10.1245/s10434-018-6638-8. Epub 2018 Jul 9.
BACKGROUND
Postoperative complications (POC) are associated with poor oncologic outcomes in gastric cancer. We sought to evaluate the impact of POC on survival in patients with gastric cancer treated with upfront surgery (UpSurg) versus those treated with preoperative therapy (PreT).
METHODS
We analyzed data from a prospectively maintained database of patients who had undergone resection of their gastric cancer at our institution. Patients with T1N0 or M1 lesions, recurrent disease, and mortality within 90 days were excluded. Survival was compared between patients with and without POC in the UpSurg and PreT groups. Cox regression analyses were used to examine factors associated with overall survival (OS) and disease-free survival (DFS).
RESULTS
A total of 421 patients underwent resection of gastric cancer: 30% underwent upfront surgery, and 51% had a POC. Among patients who had POCs, 71% were infectious and 53% were Clavien-Dindo grade III or IV. UpSurg patients with a POC had shorter OS (5-year, 47 vs. 85%; p < 0.001) and DFS (5-year, 46 vs. 76%; p < 0.001) than those without a POC. In contrast, there was no difference in OS (5-year, 57 vs. 63%; p = 0.77) and DFS (5-year, 52 vs. 52%; p = 0.52) between PreT patients with and without POC. Multivariable Cox regression model demonstrated that a POC in UpSurg patients had significant impact on DFS (2.6 [95% confidence interval (CI) 1.48-4.74]), whereas it did not in PreT patients (0.9 [95% CI 0.70-1.33]).
CONCLUSIONS
The use of preoperative therapy negated the impact of POCs on OS and DFS in patients undergoing resection for gastric cancer.
背景
术后并发症（POC）与胃癌患者的不良肿瘤学结果相关。我们旨在评估 POC 对接受 upfront 手术（UpSurg）治疗与接受术前治疗（PreT）治疗的胃癌患者生存的影响。
方法
我们分析了来自机构前瞻性维护的胃癌切除术患者数据库的数据。排除 T1N0 或 M1 病变、复发性疾病以及 90 天内死亡的患者。比较 UpSurg 和 PreT 组中有无 POC 的患者的生存情况。使用 Cox 回归分析来检查与总生存（OS）和无病生存（DFS）相关的因素。
结果
共 421 例患者接受了胃癌切除术：30%接受了 upfront 手术，51%发生了 POC。在发生 POC 的患者中，71%为感染性，53%为 Clavien-Dindo 分级 III 或 IV 级。有 POC 的 UpSurg 患者的 OS（5 年，47% vs. 85%；p<0.001）和 DFS（5 年，46% vs. 76%；p<0.001）均较无 POC 的患者短。相反，PreT 患者有无 POC 之间的 OS（5 年，57% vs. 63%；p=0.77）和 DFS（5 年，52% vs. 52%；p=0.52）无差异。多变量 Cox 回归模型表明，UpSurg 患者的 POC 对 DFS 有显著影响（2.6[95%置信区间（CI）1.48-4.74]），而 PreT 患者则没有（0.9[95%CI 0.70-1.33]）。
结论
术前治疗的应用消除了 POC 对接受胃癌切除术患者 OS 和 DFS 的影响。
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