Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Dig Surg. 2020;37(3):249-257. doi: 10.1159/000501678. Epub 2019 Jul 24.
Both neo-adjuvant chemoradiation therapy (NACRT) and neo-adjuvant chemotherapy (NAC), in addition to surgical resection of gastric cardia cancer, improves survival outcomes. We assessed whether NACRT or NAC had superior overall survival (OS) and relative survival (RS) outcomes using the National Cancer Database (NCDB).
The NCDB from 2006 to 2014 was reviewed to identify non-metastatic adult gastric cardia cancer patients who underwent surgical resection and received NACRT or NAC. Advanced statistical models were applied to assess survival outcomes.
Of the 5,371 patients included, 4,520 (84.2%) were male, the mean age was 61.2 years (SD 10.0), 4,229 (78.7%) underwent NACRT, and 1,142 (21.3%) underwent NAC. NACRT patients more often had an R0 resection compared to NAC (91.4 vs. 86.6%, p < 0.001, respectively). Univariate 5-year OS rates were 40.0% (95% CI 38.2-41.8) for NACRT and 40.1% (37.0-43.6) for NAC (p = 0.302). No differences in OS for NAC vs. NACRT were found after multivariable analysis (hazard ratio [HR] 0.95, 95% CI 0.86-1.05, p = 0.290). There were no survival differences after stepwise, propensity score, RS analyses, nor after near-far-matching (HR 0.94, 95% CI 0.82-1.07, p = 0.332).
NAC or NACRT yield the same survival outcome for patients with resectable gastric cardia cancer. These data support the need for randomized controlled trials comparing the 2 regimens head-to-head.
新辅助放化疗（NACRT）和新辅助化疗（NAC）联合胃贲门癌手术切除可改善生存结局。我们利用国家癌症数据库（NCDB）评估 NACRT 或 NAC 是否具有更优的总生存（OS）和相对生存（RS）结局。
回顾 2006 年至 2014 年 NCDB，以确定接受手术切除并接受 NACRT 或 NAC 的非转移性成年胃贲门癌患者。应用高级统计模型评估生存结局。
5371 例患者中，4520 例（84.2%）为男性，平均年龄为 61.2 岁（标准差 10.0），4229 例（78.7%）接受 NACRT，1142 例（21.3%）接受 NAC。与 NAC 相比，NACRT 患者的 R0 切除率更高（91.4%比 86.6%，p<0.001）。NACRT 和 NAC 的单变量 5 年 OS 率分别为 40.0%（95%CI 38.2-41.8）和 40.1%（37.0-43.6）（p=0.302）。多变量分析后，NAC 与 NACRT 的 OS 无差异（风险比[HR]0.95，95%CI 0.86-1.05，p=0.290）。逐步、倾向评分、RS 分析以及近-远匹配后均未发现生存差异（HR 0.94，95%CI 0.82-1.07，p=0.332）。
NAC 或 NACRT 可使可切除胃贲门癌患者获得相同的生存结局。这些数据支持需要开展头对头比较这两种方案的随机对照试验。
