多原发胃癌的临床病理特征及辅助化疗对长期生存的影响：倾向评分匹配分析。

Clinicopathological features and impact of adjuvant chemotherapy on the long-term survival of patients with multiple gastric cancers: a propensity score matching analysis.

机构信息

Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, P. R. China.

Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, P. R. China.

出版信息

Cancer Commun (Lond). 2019 Feb 11;39(1):4. doi: 10.1186/s40880-019-0350-3.

DOI:10.1186/s40880-019-0350-3

PMID:30744696

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6371440/

Abstract

BACKGROUND

Little is known about the correlation between the clinicopathological features, postoperative treatment, and prognosis of multiple gastric cancers (MGCs). In this study, we aimed to investigate the correlation between these features and the impact of postoperative adjuvant chemotherapy on the long-term survival of patients with MGC.

METHODS

The clinical and pathological data of patients diagnosed with gastric adenocarcinoma who had radical gastrectomy from January 2007 to December 2016 were analyzed. Using propensity score matching, the prognostic differences, and the impact of postoperative adjuvant chemotherapy between those with MGC and solitary gastric cancers (SGC) were compared.

RESULTS

Among the 4107 patients investigated, the incidence of MGC was 3.2% (133/4107). Before matching, patients with MGC and SGC had disparities in the type of gastrectomy, pathological tumor stage (pT), pathological node stage (pN), and pathological tumor-node-metastasis stage (pTNM). After a 1:4 ratio matching, the clinical data of 133 cases of MGC and 532 cases of SGC were found to be comparable. The 5-year overall survival (OS) rate was 56.6% in the entire matched cohort, 48.1% in the MGC group, and 58.7% in the SGC group (P = 0.013). Multivariate analysis revealed that MGC, age, pT stage, pN stage, and adjuvant chemotherapy were independent predictors of OS (all P < 0.05). Stratified analyses demonstrated that for the cohort of advanced gastric cancer (AGC) patients who did not had adjuvant chemotherapy, the 5-year OS rate of advanced cases of MGC was inferior than that of SGC patients (34.0% vs. 46.1%, respectively; P = 0.025) but there were no significant difference in the 5-year OS rate between advanced MGC and SGC patients who had adjuvant chemotherapy (48.0% vs. 53.3%, respectively; P = 0.292). Further, we found that the 5-year OS rate of advanced MGC who had adjuvant chemotherapy was significantly higher than those who did not had adjuvant chemotherapy (48.0% vs. 34.0%, P = 0.026).

CONCLUSIONS

Patients with advanced MGC was identified as having a poorer survival as to SGC patients, but the implementation of postoperative adjuvant chemotherapy showed that it had the potential to significantly improve the long-term prognoses of MGC patients.

摘要

背景

关于多发性胃癌（MGC）的临床病理特征、术后治疗与预后之间的相关性，目前所知甚少。本研究旨在探讨这些特征之间的相关性，以及术后辅助化疗对 MGC 患者长期生存的影响。

方法

分析 2007 年 1 月至 2016 年 12 月接受根治性胃切除术的胃腺癌患者的临床病理资料。采用倾向评分匹配比较 MGC 与单发胃癌（SGC）患者的预后差异和术后辅助化疗的影响。

结果

在 4107 例患者中，MGC 的发生率为 3.2%（133/4107）。在匹配前，MGC 和 SGC 患者的胃切除术类型、病理肿瘤分期（pT）、病理淋巴结分期（pN）和病理肿瘤-淋巴结-转移分期（pTNM）存在差异。经 1:4 比例匹配后，MGC 组 133 例和 SGC 组 532 例的临床资料具有可比性。全匹配队列的 5 年总生存率（OS）为 56.6%，MGC 组为 48.1%，SGC 组为 58.7%（P=0.013）。多因素分析显示，MGC、年龄、pT 分期、pN 分期和辅助化疗是 OS 的独立预后因素（均 P<0.05）。分层分析显示，对于未接受辅助化疗的进展期胃癌（AGC）患者队列，进展期 MGC 的 5 年 OS 率低于 SGC 患者（分别为 34.0%和 46.1%，P=0.025），但进展期 MGC 和接受辅助化疗的 SGC 患者的 5 年 OS 率无显著差异（分别为 48.0%和 53.3%，P=0.292）。此外，我们发现进展期 MGC 患者接受辅助化疗的 5 年 OS 率明显高于未接受辅助化疗的患者（分别为 48.0%和 34.0%，P=0.026）。