Department of Oncology, Operative Unit of Oncology, ASST of Cremona, Hospital of Cremona, Viale Concordia 1, 26100, Cremona, Italy.
Department of Surgery, Operative Unit of General Surgery, ASST of Cremona, Hospital of Cremona, Cremona, Italy.
Clin Transl Oncol. 2020 Jul;22(7):1004-1012. doi: 10.1007/s12094-019-02220-w. Epub 2019 Oct 10.
Incidence of gastric cancer (GC) shows different distribution in Italy, with higher incidence in the north and center. We retrospectively analyzed the clinical data of patients resected at the Hospital of Cremona between January 2007 and December 2016. Available clinical variables were linked with survival to identify possible prognostic factors.
Variables analyzed were age, sex, type of surgery, site, histology, invasion, nodal status, resection margins, grade, HER2 status, Helicobacter pylori infection (neo)adjuvant chemotherapy, adjuvant chemoradiotherapy, neutrophil-to-lymphocyte ratio, number of nodes removed and type of lymphadenectomy. Overall survival (OS) was estimated by the Kaplan-Meier method and differences between groups by the log-rank test. Data on OS were analyzed by Cox regression and the final model was obtained using the step-wise method.
379 patients were considered, out of which 195 were operated from 2007 to 2011 and 184 from 2012 to 2016. Median follow-up was 25.5 months, median OS 31.3 months and time to recurrence 23.2 months. D2 resection rate increased from 36% (period 2007-2011) to 74% in 2012-2016 (p = 0.01) with a higher mean number of nodes collected (20.98 for 2007-2011 and 23.53 for 2012-2016, p = 0.040). Only 37% of patients received a postoperative treatment. At multivariate analysis, variables associated with OS were age (p = 0.002), stage (p < 0.001), resection margins status (p < 0.001), adjuvant chemotherapy (p < 0.010) and tumor location (cardia vs non-cardia) (p = 0.029).
Our analysis shows that completeness of resection and lower stage are strong predictors of long-term survival in GC, providing the rationale for adjuvant and neoadjuvant approaches (chemotherapy, radiotherapy or combined). Cardial GC has worse prognosis compared to distal cancers.
Service evaluation number 256, protocol 16821/17, date 05 June 2017.
意大利的胃癌（GC）发病率分布不同，北部和中部的发病率较高。我们回顾性分析了 2007 年 1 月至 2016 年 12 月在克雷莫纳医院接受手术的患者的临床数据。将可用的临床变量与生存相关联，以确定可能的预后因素。
分析的变量包括年龄、性别、手术类型、部位、组织学、浸润、淋巴结状态、切缘、分级、HER2 状态、幽门螺杆菌感染（新辅助）化疗、辅助放化疗、中性粒细胞与淋巴细胞比值、淋巴结切除数和淋巴结清扫类型。通过 Kaplan-Meier 方法估计总生存期（OS），并通过对数秩检验比较组间差异。通过 Cox 回归分析 OS 数据，使用逐步法获得最终模型。
共纳入 379 例患者，其中 195 例患者于 2007 年至 2011 年接受手术，184 例患者于 2012 年至 2016 年接受手术。中位随访时间为 25.5 个月，中位 OS 为 31.3 个月，复发时间为 23.2 个月。D2 切除术的比例从 2007-2011 年的 36%增加到 2012-2016 年的 74%（p=0.01），收集的平均淋巴结数也有所增加（2007-2011 年为 20.98，2012-2016 年为 23.53，p=0.040）。仅有 37%的患者接受了术后治疗。多变量分析显示，与 OS 相关的变量包括年龄（p=0.002）、分期（p<0.001）、切缘状态（p<0.001）、辅助化疗（p<0.010）和肿瘤位置（贲门 vs 非贲门）（p=0.029）。
我们的分析表明，GC 患者的手术切除完整性和较低的分期是长期生存的有力预测因素，为辅助和新辅助治疗（化疗、放疗或联合治疗）提供了依据。贲门 GC 的预后较远端癌症差。
服务评估编号 256，方案 16821/17，日期 2017 年 6 月 5 日。
