全胃或次全胃切除及D2淋巴结清扫术后辅助放化疗可提高进展期胃癌患者的生存率？
ADJUVANT CHEMORADIOTHERAPY AFTER SUBTOTAL OR TOTAL GASTRECTOMY AND D2 LIMPHADENECTOMY INCREASES SURVIVAL IN ADVANCED GASTRIC CANCER?
作者信息
Andreollo Nelson Adami, Drizlionoks Eric, Tercioti-Junior Valdir, Coelho-Neto João de Souza, Ferrer José Antonio Possato, Carvalheira José Barreto Campello, Lopes Luiz Roberto
机构信息
Digestive Diseases Surgical Unit and Gastrocenter, Campinas, SP, Brazil.
Division of Oncology, Department of Surgery and Internal Medicine, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil.
出版信息
Arq Bras Cir Dig. 2019 Dec 20;32(4):e1464. doi: 10.1590/0102-672020190001e1464. eCollection 2019.
BACKGROUND
The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival.
AIM
To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy.
METHODS
Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival.
RESULTS
The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival.
CONCLUSION
Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.
背景
以治愈为目的的晚期胃癌治疗主要是手术治疗，放化疗作为新辅助或辅助治疗用于控制疾病和延长生存期。
目的
评估接受D2淋巴结清扫的次全或全胃切除术后辅助放化疗患者的生存期。
方法
回顾性分析87例接受胃切除的晚期胃腺癌患者，这些患者被认为处于IB期至IIIC期，并接受辅助放化疗（INT 0116方案）。排除食管胃交界部肿瘤、有腹膜种植转移、远处转移以及手术切缘阳性或术后早期死亡的患者。根据胃切除范围将患者分组，并分析肿瘤部位、组织病理学、淋巴结侵犯情况、分期、发病率和生存期。
结果
成功完成辅助治疗的患者总数为45例（51.7%）。因毒性反应、肿瘤进展或失访而开始治疗但中断治疗的患者有10例（11.5%），报告为辅助治疗不完整。拒绝或未开始辅助治疗的患者有33例（48.3%）。60例（68.9%）患者行次全胃切除术，27例（31.1%）行全胃切除术，全胃切除术患者生存期较短。平均切除淋巴结数为30.8个。分期和受累淋巴结数量是生存期较差和肿瘤越晚期的预测因素。与辅助放化疗不完整或仅接受手术的患者相比，接受完整放化疗的辅助治疗患者生存期更长。另一方面，比较完全接受辅助治疗的T4b期（IIIB + IIIC期）患者与仅接受手术或未完成辅助治疗的患者，生存期有显著差异。
结论
辅助放化疗可使接受根治性手术治疗的T4b期患者生存期延长。
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