Bauer Katrin, Manzini Giulia, Henne-Bruns Doris, Buechler Peter
Department for General, Visceral, Thoracic and Paediatric Surgery, Clinic of Kempten, Kempten 87439, Germany.
Department of General and Visceral Surgery, University Hospital of Ulm, Ulm 89081, Germany.
World J Gastrointest Oncol. 2020 May 15;12(5):559-568. doi: 10.4251/wjgo.v12.i5.559.
Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer (> T2, N+) before tumour resection in many European guidelines. However, there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours, in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.
To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy, localisation, and age.
We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016. The data were evaluated particularly in relation to patient age, tumour site, and perioperative therapy.
Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population. The 5-year survival rates were 40% for patients who received perioperative chemotherapy and 29% for the group without perioperative chemotherapy ( = 0.125). Our patients were on average distinctly older than patients in most of the published randomised controlled trials. Patients elder than 75 years received perioperative chemotherapy far less frequently. Patients with a proximal tumour received perioperative chemotherapy much more often.
This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer. There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.
在许多欧洲指南中，新辅助/围手术期化疗是胃癌晚期（> T2，N+）在肿瘤切除术前的推荐治疗方法。然而，围手术期化疗在远端肿瘤与近端肿瘤中是否同样有效尚无共识，此外，老年患者的合适治疗方式也存在相关不确定性。
研究围手术期化疗在德国一家三级诊所的晚期胃癌患者中的疗效、肿瘤位置及年龄方面的作用。
我们对2008年至2016年间在我们诊所接受胃或胃食管交界腺癌切除术的158例患者进行了回顾性分析。特别针对患者年龄、肿瘤部位和围手术期治疗对数据进行了评估。
在我们的研究人群中，围手术期化疗并未带来显著的生存优势。接受围手术期化疗的患者5年生存率为40%，未接受围手术期化疗的组为29%（P = 0.125）。我们的患者平均年龄明显高于大多数已发表的随机对照试验中的患者。75岁以上的患者接受围手术期化疗的频率要低得多。近端肿瘤患者接受围手术期化疗的频率要高得多。
该分析再次证实了我们之前关于围手术期化疗对晚期胃癌有效性的数据。现有随机对照试验的质量是否足以普遍证明晚期胃癌患者无论肿瘤位置或年龄均适合接受围手术期化疗，这存在合理疑问。
