Gastrointestinal Surgery Department, Instituto do Câncer - Universidade de Sao Paulo, Sao Paulo, Brazil.
J Surg Oncol. 2020 Apr;121(5):833-839. doi: 10.1002/jso.25839. Epub 2020 Jan 14.
Neoadjuvant chemotherapy (NACT) followed by radical surgery represents a treatment option for patients with advanced gastric cancer (GC). This case-control study aimed to evaluate the clinicopathological characteristics and surgical outcomes of GC patients who received NACT, and its impact on survival.
We retrospectively reviewed all patients with GC who underwent gastrectomy. A total of 45 cases with NACT were matched with consecutive 45 patients who underwent upfront gastrectomy for the following characteristics: gender, age, gastrectomy type, lymphadenectomy extent, American Society of Anesthesiologists class, histological type, cT and cN.
NACT group had smaller tumors (4.9 vs 6.8 cm P = .006), lower lymphatic invasion rate (40% vs 73.3%, P = .001), lower venous invasion rate (18% vs 46.7%, P = .003) and lower perineural invasion rate (35% vs 77.8%, P < .0001). The ypTNM stage was lower in patients treated with NACT (P < .001). The major postoperative complication (POC) rate was lower in NACT patients (6.7% vs 24.4%, P = .02), as was hospital length of stay (10.8 vs 17 days, P = .005).
NACT allowed nodal and tumor downstaging. In addition, patients who underwent NACT had fewer POC and shorter length of hospital stay.
新辅助化疗（NACT）后行根治性手术是晚期胃癌（GC）患者的一种治疗选择。本病例对照研究旨在评估接受 NACT 的 GC 患者的临床病理特征和手术结果，并评估其对生存的影响。
我们回顾性分析了所有接受胃切除术的 GC 患者。共有 45 例接受 NACT 的患者与连续 45 例接受直接胃切除术的患者相匹配，这些患者具有以下特征：性别、年龄、胃切除术类型、淋巴结清扫程度、美国麻醉医师协会分级、组织学类型、cT 和 cN。
NACT 组肿瘤较小（4.9 对 6.8cm，P=0.006），淋巴管侵犯率较低（40%对 73.3%，P=0.001），静脉侵犯率较低（18%对 46.7%，P=0.003），神经侵犯率较低（35%对 77.8%，P<0.0001）。接受 NACT 治疗的患者 ypTNM 分期较低（P<0.001）。NACT 组患者主要术后并发症（POC）发生率较低（6.7%对 24.4%，P=0.02），住院时间较短（10.8 对 17 天，P=0.005）。
NACT 可使淋巴结和肿瘤降期。此外，接受 NACT 的患者 POC 较少，住院时间较短。
