新辅助化疗可改善胃神经内分泌癌和混合性腺神经内分泌癌患者的生存。
Neoadjuvant chemotherapy improves the survival of patients with neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma of the stomach.
机构信息
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
出版信息
J Cancer Res Clin Oncol. 2020 Aug;146(8):2135-2142. doi: 10.1007/s00432-020-03214-w. Epub 2020 Apr 18.
PURPOSE
The impact of neoadjuvant chemotherapy (NAC) on patients with neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine carcinoma (MANEC) of the stomach is unclear. The aim of this retrospective study was to evaluate the effects of NAC on patients with these conditions.
METHODS
This study included patients with locally advanced NEC or MANEC of the stomach who underwent gastrectomy. Histologic and prognostic effects of NAC were assessed. The overall survival (OS) rate was used to compare treatment efficacies between NAC patients and surgery-first patients.
RESULTS
Of the 69 patients included in this study, 20 received NAC and 49 underwent surgery first after diagnosis. A total of 13 patients responded to NAC (including 3 with complete remission and 10 with partial remission) and 7 patients acquired stable disease status according to the Response Evaluation Criteria in Solid Tumors version 1.1. One patient (5%) achieved a pathological complete response after NAC. Pathological tumor regression grades 1, 2, 3, 4, and 5 were observed in 1 (5%), 5 (25%), 3 (15%), 10 (50%), and 1 (5%) patient(s) with NAC, respectively. The incidence of postoperative complications was similar in the two groups. Patients in the NAC group demonstrated better OS than did patients in the surgery-first group (P = 0.032). Multivariate analyses showed that NAC, adjuvant chemotherapy, and the clinical N stage were independent factors affecting OS.
CONCLUSION
In patients with locally advanced NEC and MANEC of the stomach, NAC significantly improved OS.
目的
新辅助化疗（NAC）对胃神经内分泌癌（NEC）和混合性腺神经内分泌癌（MANEC）患者的影响尚不清楚。本回顾性研究旨在评估 NAC 对这些患者的影响。
方法
本研究纳入了接受胃切除术的局部晚期 NEC 或胃 MANEC 患者。评估了 NAC 的组织学和预后影响。使用总生存期（OS）率来比较 NAC 患者和先手术患者的治疗效果。
结果
本研究共纳入 69 例患者，其中 20 例接受 NAC，49 例在诊断后直接进行手术。共有 13 例患者对 NAC 有反应（包括完全缓解 3 例和部分缓解 10 例），7 例患者根据实体瘤反应评价标准 1.1 获得稳定疾病状态。1 例患者（5%）在 NAC 后获得病理完全缓解。NAC 组中，1 例（5%）患者肿瘤病理分级为 1 级，5 例（25%）患者肿瘤病理分级为 2 级，3 例（15%）患者肿瘤病理分级为 3 级，10 例（50%）患者肿瘤病理分级为 4 级，1 例（5%）患者肿瘤病理分级为 5 级。两组患者的术后并发症发生率相似。NAC 组患者的 OS 明显优于先手术组（P=0.032）。多因素分析显示，NAC、辅助化疗和临床 N 分期是影响 OS 的独立因素。
结论
对于局部晚期 NEC 和胃 MANEC 患者，NAC 显著提高了 OS。
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