Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2019 Oct;26(11):3602-3610. doi: 10.1245/s10434-019-07638-8. Epub 2019 Jul 26.
Pathologic complete response of a primary tumor (ypT0) after preoperative therapy is associated with improved overall survival (OS). However, whether other variables are associated with outcome for gastric cancer patients with ypT0 status is unknown.
This study reviewed an institutional database of patients who underwent resection of gastric or gastroesophageal adenocarcinoma after preoperative therapy and identified patients with ypT0 status. Cox regression models were used to identify clinicopathologic predictors of OS.
Of 77 patients with ypT0 status identified in this study, 36 (47%) had gastroesophageal junction tumors. At presentation, 62 patients (81%) had clinical T3 disease, and 7 (9%) had clinical T4 disease. The clinical nodal status was positive (cN+) for 45 patients (58%). Preoperative chemoradiation was administered to 75 patients (97%). The median follow-up duration was 3.54 years. The median OS was 10 years, and the 5-year OS rate was 61%. Univariable analysis identified age of 65 years or older at the time of diagnosis, histologic grade, and ypN status as significant predictors of OS. Multivariable analysis confirmed age of 65 years or older [hazard ratio (HR), 4.26; p < 0.001] and persistent nodal disease (ypN+ status; HR, 5.12; p < 0.001) to be independently associated with OS. Clinical stage was not associated with survival. In the subset of ypT0N0 patients, no clinicopathologic feature was predictive of survival.
For gastric or gastroesophageal adenocarcinoma patients with ypT0 status after preoperative therapy, ypN+ status substantially reduced survival. Pretreatment clinical stage had no impact on OS for patients with a pathologic complete response.
原发肿瘤经术前治疗后达到病理完全缓解（ypT0）与总生存（OS）改善相关。然而，对于 ypT0 状态的胃癌患者，其他变量是否与预后相关尚不清楚。
本研究回顾性分析了接受术前治疗后行胃或胃食管腺癌切除术患者的机构数据库，并确定了 ypT0 状态的患者。使用 Cox 回归模型确定 OS 的临床病理预测因素。
在本研究中确定的 77 例 ypT0 状态患者中，有 36 例（47%）为胃食管结合部肿瘤。就诊时，62 例（81%）患者为临床 T3 期疾病，7 例（9%）患者为临床 T4 期疾病。45 例（58%）患者的临床淋巴结状态为阳性（cN+）。75 例（97%）患者接受了术前放化疗。中位随访时间为 3.54 年。中位 OS 为 10 年，5 年 OS 率为 61%。单变量分析确定诊断时年龄 65 岁或以上、组织学分级和 ypN 状态是 OS 的显著预测因素。多变量分析证实年龄 65 岁或以上（危险比 [HR]，4.26；p<0.001）和持续存在的淋巴结疾病（ypN+状态；HR，5.12；p<0.001）与 OS 独立相关。临床分期与生存无关。在 ypT0N0 患者亚组中，没有临床病理特征可预测生存。
对于接受术前治疗后 ypT0 状态的胃或胃食管腺癌患者，ypN+状态显著降低了生存。术前临床分期对病理完全缓解患者的 OS 没有影响。
