Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Winship Research Informatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Cancer. 2020 Jan 1;126(1):37-45. doi: 10.1002/cncr.32516. Epub 2019 Sep 18.
Perioperative chemotherapy (POC) is one standard approach for the treatment of resectable cancers of the stomach and gastroesophageal junction (GEJ), whereas there has been growing interest in preoperative therapies. The objective of the current study was to compare survival between patients treated with preoperative chemoradiotherapy and adjuvant chemotherapy (PCRT) with those receiving POC using a large database.
The National Cancer Data Base was queried for patients diagnosed between 2004 and 2013 with American Joint Committee on Cancer clinical group stage IB to stage IIIC (excluding T2N0 disease) adenocarcinoma of the stomach or GEJ. Patients treated with definitive surgery and POC with or without preoperative radiotherapy of 41 to 54 Gy were included. Overall survival (OS) was defined from the date of definitive surgery and estimated using the Kaplan-Meier method. A total of 14 patient and treatment variables were used for propensity score matching (PSM).
A total of 1048 patients were analyzed: 53.2% received POC and 46.8% received PCRT. The primary tumor site was the GEJ in 69.1% of patients and stomach in 30.9% of patients. The median age of the patients was 60 years, and the median follow-up was 25.8 months. The use of PCRT was associated with a greater pathologic complete response rate of 13.1% versus 8.2% (P = .01). POC was associated with a decreased risk of death in unmatched groups (hazard ratio [HR], 0.83; P = .043). Using PSM cohorts, POC decreased the risk of death with a median OS of 45.1 months versus 31.4 months (HR, 0.70; P = .016). The 2-year OS rate was 72.9% versus 62.5% and the 5-year OS rate was 40.7% versus 33.1% for POC versus PCRT, respectively. Survival favored POC in PSM gastric (HR, 0.41; P = .07) and GEJ (HR, 0.77; P = .08) patient subgroups.
The addition of preoperative radiotherapy to POC appears to be associated with an increased risk of death in patients with resectable gastric and GEJ cancers.
围手术期化疗（POC）是治疗可切除胃癌和胃食管交界处（GEJ）癌症的一种标准方法，而术前治疗的兴趣日益浓厚。本研究的目的是使用大型数据库比较接受术前放化疗和辅助化疗（PCRT）与接受 POC 治疗的患者的生存情况。
从 2004 年至 2013 年，美国癌症联合委员会临床组分期 IB 至 IIIC（不包括 T2N0 疾病）的胃或 GEJ 腺癌患者的国家癌症数据库中查询患者。包括接受确定性手术和 POC 治疗的患者，包括术前放疗 41 至 54Gy。总生存期（OS）从确定性手术开始计算，并使用 Kaplan-Meier 方法进行估计。共使用 14 个患者和治疗变量进行倾向评分匹配（PSM）。
共分析了 1048 例患者：53.2%接受 POC，46.8%接受 PCRT。主要肿瘤部位为胃食管交界处的占 69.1%，胃的占 30.9%。患者的中位年龄为 60 岁，中位随访时间为 25.8 个月。PCRT 的使用与 13.1%的病理完全缓解率相比，8.2%（P=.01）的完全缓解率更高。在未匹配组中，POC 与死亡风险降低相关（风险比[HR]，0.83；P=.043）。使用 PSM 队列，POC 降低了死亡风险，中位 OS 为 45.1 个月，而 31.4 个月（HR，0.70；P=.016）。2 年 OS 率分别为 72.9%和 62.5%，5 年 OS 率分别为 40.7%和 33.1%，POC 与 PCRT 相比。POC 更有利于 PSM 胃（HR，0.41；P=.07）和 GEJ（HR，0.77；P=.08）患者亚组的生存。
在可切除的胃和 GEJ 癌症患者中，术前放疗联合 POC 似乎会增加死亡风险。
