Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2020 Mar;27(3):802-811. doi: 10.1245/s10434-019-08170-5. Epub 2020 Jan 1.
This study aimed to compare the long-term survival of patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy for gastric adenocarcinoma (GA) in the United States and China.
Data on patients with GA who underwent gastrectomy without neoadjuvant therapy were retrieved from prospectively maintained databases at Memorial Sloan Kettering Cancer Center (MSKCC) and Fujian Medical University Union Hospital (FMUUH). Using propensity score-matching (PSM), equally sized cohorts of patients with similar clinical and pathologic characteristics who underwent minimally invasive versus open gastrectomy were selected. The primary end point of the study was 5-year overall survival (OS).
The study identified 479 patients who underwent gastrectomy at MSKCC between 2000 and 2012 and 2935 patients who underwent gastrectomy at FMUUH between 2006 and 2014. Of the total 3432 patients, 1355 underwent minimally invasive gastrectomy, and 2059 underwent open gastrectomy. All the patients had at least 5 years of potential follow-up evaluation. Before PSM, most patient characteristics differed significantly between the patients undergoing the two types of surgery. After PSM, each cohort included 889 matched patients, and the actual 5-year OS did not differ significantly between the two cohorts, with an OS rate of 54% after minimally invasive gastrectomy and 50.4% after open gastrectomy (p = 0.205). Subgroup analysis confirmed that survival was similar between surgical cohorts among the patients for each stage of GA and for those undergoing distal versus total/proximal gastrectomy. In the multivariable analysis, surgical approach was not an independent prognostic factor.
After PSM of U.S. and Chinese patients with GA undergoing gastrectomy, long-term survival did not differ significantly between the patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy.
本研究旨在比较美国和中国接受微创胃切除术和开放胃切除术治疗胃腺癌（GA）患者的长期生存情况。
从纪念斯隆凯特琳癌症中心（MSKCC）和福建医科大学附属协和医院（FMUUH）前瞻性维护的数据库中检索了未接受新辅助治疗的 GA 患者接受胃切除术的数据。使用倾向评分匹配（PSM），选择了接受微创与开放胃切除术的具有相似临床和病理特征的患者的大小相等的队列。该研究的主要终点是 5 年总生存率（OS）。
该研究确定了 2000 年至 2012 年期间在 MSKCC 接受胃切除术的 479 例患者和 2006 年至 2014 年期间在 FMUUH 接受胃切除术的 2935 例患者。在总共 3432 例患者中，有 1355 例接受了微创胃切除术，2059 例接受了开放胃切除术。所有患者都有至少 5 年的潜在随访评估。在 PSM 之前，两种手术患者的大多数患者特征存在显著差异。PSM 后，每个队列均包括 889 例匹配患者，并且两种队列之间的实际 5 年 OS 没有显著差异，微创胃切除术的 OS 率为 54%，开放胃切除术的 OS 率为 50.4%（p=0.205）。亚组分析证实，在每个 GA 分期和远端与全/近端胃切除术的患者中，手术队列之间的生存情况相似。在多变量分析中，手术方式不是独立的预后因素。
对接受胃切除术的美国和中国 GA 患者进行 PSM 后，微创胃切除术和开放胃切除术患者的长期生存情况无显著差异。
