Department of Surgery, Yao Municipal Hospital, Osaka, Japan
Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Osaka, Japan.
Anticancer Res. 2020 Apr;40(4):2351-2357. doi: 10.21873/anticanres.14203.
BACKGROUND/AIM: The prognosis of gastric cancer with para-aortic or bulky lymph node metastases is poor, but the JCOG 0405 study showed relatively good outcomes of neoadjuvant chemotherapy and gastrectomy with para-aortic lymph node dissection. We investigated the prognostic factors for this treatment.
Twenty patients who underwent gastrectomy and para-aortic lymph node dissection after chemotherapy were enrolled from two institutions. The prognostic factors for overall survival were retrospectively analysed using Cox's proportional hazard models.
The univariate analyses revealed that ypN (3/0-2, p=0.001), ypM1 (para-aortic LYM) (yes/no, p=0.03), histological response (Grade0-1b/2-3, p=0.02), and adjuvant chemotherapy (no/yes, p=0.02) were significant prognostic factors, whereas multivariate analysis revealed ypN and absence of adjuvant chemotherapy to be independent prognostic factors.
Posttreatment nodal status may be the best surrogate marker for gastric cancer with gastrectomy and para-aortic lymph node dissection after neoadjuvant chemotherapy. Adjuvant chemotherapy seems to be essential to improve survival.
背景/目的：伴有腹主动脉旁或大体积淋巴结转移的胃癌预后较差，但 JCOG 0405 研究显示新辅助化疗和胃切除术联合腹主动脉旁淋巴结清扫术的治疗效果相对较好。我们研究了这种治疗方法的预后因素。
从两个机构共纳入了 20 名接受化疗后行胃切除术和腹主动脉旁淋巴结清扫术的患者。采用 Cox 比例风险模型对总生存期的预后因素进行了回顾性分析。
单因素分析显示，ypN（3/0-2，p=0.001）、ypM1（腹主动脉 LYM）（是/否，p=0.03）、组织学反应（Grade0-1b/2-3，p=0.02）和辅助化疗（否/是，p=0.02）是显著的预后因素，而多因素分析显示 ypN 和无辅助化疗是独立的预后因素。
治疗后淋巴结状态可能是新辅助化疗后行胃切除术和腹主动脉旁淋巴结清扫术的胃癌的最佳替代标志物。辅助化疗似乎是提高生存的关键。
