Zurlo Ina Valeria, Basso Michele, Strippoli Antonia, Calegari Maria Alessandra, Orlandi Armando, Cassano Alessandra, Di Salvatore Mariantonietta, Garufi Giovanna, Bria Emilio, Tortora Giampaolo, Barone Carlo, Pozzo Carmelo
Comprehensive Cancer Center, Università Cattolica del Sacro Cuore-IRCCS, 00168 Rome, Italy.
Comprehensive Cancer Center, Policlinico Universitario "Agostino Gemelli"-IRCSS, 00168 Roma, Italy.
Cancers (Basel). 2020 Jul 1;12(7):1749. doi: 10.3390/cancers12071749.
: Guidelines recommend a perioperative approach in patients with stage II/III gastric cancer, but in real-life many patients receive immediate surgery followed by adjuvant chemotherapy (aCT). Although histologic subtypes may have different response to CT, no study has explored the influence of histotype on the efficacy of perioperative CT (pCT) or aCT. : The objective of the study was to evaluate the impact of clinicopathological features and histology (intestinal or diffuse) on survival according to strategy (pCT vs. aCT). The primary endpoint was overall survival (OS) and the secondary endpoint was event-free survival (EFS). Out of 203 patients affected by LAGC, 83 received pCT and 120 aCT. At multivariate, histology and LVI in pCT cohort and positive resection margin in the aCT influenced both OS and EFS. No difference in EFS and OS was observed in relation to strategy. However, in the intestinal-type of pCT cohort survival outcomes were significantly higher compared to the aCT cohort, whereas in the diffuse-type were significantly worse in patients receiving pCT compared to those receiving aCT. Although retrospective and small-sized, this study suggests that the benefit of pCT might be limited to the intestinal-type. This hypothesis needs to be confirmed in prospective series.
指南推荐了针对II/III期胃癌患者的围手术期治疗方案，但在现实生活中，许多患者接受直接手术，随后进行辅助化疗（aCT）。尽管组织学亚型对化疗的反应可能不同，但尚无研究探讨组织学类型对围手术期化疗（pCT）或辅助化疗疗效的影响。 本研究的目的是根据治疗策略（pCT与aCT）评估临床病理特征和组织学类型（肠型或弥漫型）对生存的影响。主要终点是总生存期（OS），次要终点是无事件生存期（EFS）。在203例局部进展期胃癌（LAGC）患者中，83例接受了pCT，120例接受了aCT。多因素分析显示，pCT队列中的组织学类型和淋巴管侵犯（LVI）以及aCT队列中的切缘阳性对OS和EFS均有影响。未观察到治疗策略在EFS和OS方面存在差异。然而，在pCT队列的肠型中，生存结局显著高于aCT队列，而在弥漫型中，接受pCT的患者与接受aCT的患者相比生存结局显著更差。尽管本研究为回顾性且样本量较小，但提示pCT的获益可能仅限于肠型。这一假设需要在前瞻性研究中得到证实。
