用于选择晚期胃癌患者进行转化手术的风险分层模型。
Risk-stratification model to select conversion surgery for advanced gastric cancer patients.
作者信息
Nie Runcong, Yuan Shuqiang, Li Yuanfang, Chen Shi, Li Shuman, Yang Lirong, Yang Lifang, Chen Yingbo, Zhou Zhiwei
机构信息
Department of Gastric Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
Department of Gastric Surgery, The 6th Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
出版信息
Chin J Cancer Res. 2019 Feb;31(1):178-187. doi: 10.21147/j.issn.1000-9604.2019.01.13.
OBJECTIVE
Conversion surgery is a surgery with a purpose of R0 resection in primary advanced gastric cancer (GC) that responded well to systemic chemotherapy. This study aimed to explore the efficacy of conversion surgery for advanced GC.
METHODS
A total of 618 advanced GC patients receiving systemic chemotherapy were stratified into low-, moderate- and high-risk groups based on a nomogram-predicted probability of overall survival. The survival of conversion surgery and chemotherapy alone groups was compared using the log-rank test and Cox regression analysis after propensity score matching (PSM).
RESULTS
A nomogram with good discrimination (concordance index: 0.65) and accurate calibration was constructed. After PSM, the median survival time (MST) of conversion surgery was 26.80 months, compared with 16.60 months of chemotherapy alone (P<0.001). Conversion surgery was associated with a longer MST for patients in the low-risk group (30.40 months. 20.90 months, P=0.013), whereas it was not associated with prolonged survival in the moderate- and high-risk groups (P=0.221 and P=0.131, respectively).
CONCLUSIONS
Conversion surgery was associated with longer survival, especially for low-risk population.
目的
转化手术是一种旨在对系统化疗反应良好的原发性晚期胃癌（GC）进行R0切除的手术。本研究旨在探讨晚期GC转化手术的疗效。
方法
将618例接受系统化疗的晚期GC患者根据列线图预测的总生存概率分为低、中、高风险组。在倾向得分匹配（PSM）后，使用对数秩检验和Cox回归分析比较转化手术组和单纯化疗组的生存率。
结果
构建了一个具有良好区分度（一致性指数：0.65）和准确校准的列线图。PSM后，转化手术组的中位生存时间（MST）为26.80个月，而单纯化疗组为16.60个月（P<0.001）。转化手术与低风险组患者更长的MST相关（30.40个月对20.90个月，P=0.013），而在中风险组和高风险组中与生存期延长无关（分别为P=0.221和P=0.131）。
结论
转化手术与更长的生存期相关，尤其是对于低风险人群。
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