University of Florida, College of Medicine, Gainesville, FL, USA.
Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Ann Surg Oncol. 2021 Feb;28(2):766-773. doi: 10.1245/s10434-020-08921-9. Epub 2020 Jul 31.
Few studies have compared the survival advantage of complete pathologic response (cPR) achieved through neoadjuvant chemotherapy (nCT) versus neoadjuvant chemoradiotherapy (nCRT) in gastric adenocarcinoma. Our study utilizes a large national cancer database to address this question.
This is a retrospective review of patients with clinical stage I to III gastric adenocarcinoma from 2004 to 2013 who received nCT or nCRT. Patients who achieved cPR were selected. Associations were evaluated using Mann-Whitney U and Fisher's exact tests. Survival information was summarized using standard Kaplan-Meier methods, where estimates of the median and 5-year survival rates were estimated with 95% confidence intervals.
A total of 413 patients who had cPR were identified. Eighty-four patients received nCT and 329 patients received nCRT. Patients in the nCRT group had higher clinical stage (88.4% vs. 75.0%) and more proximal location of tumors (95.4% vs. 45.2%). The nCT group (n = 84) had a 94% 5-year survival rate, while the nCRT group's (n = 329) rate was 60% (p < 0.001). On Cox regression modeling using a propensity-weighted approach, nCT treatment was an independent predictor of improved overall survival (nCRT vs. nCT; HR 10.44, p < 0.001).
The use of nCT leads to a significant increase in overall survival in patients when compared with nCRT for those who achieved cPR in gastric adenocarcinoma. While this study is limited in identifying the cause for this difference in overall survival, this important finding nonetheless requires further investigation and should be considered in the development of future gastric cancer trials.
鲜有研究比较新辅助化疗（nCT）与新辅助放化疗（nCRT）治疗胃腺癌获得完全病理缓解（cPR）的生存优势。本研究利用大型国家癌症数据库来解决这一问题。
这是一项回顾性研究，纳入 2004 年至 2013 年间接受 nCT 或 nCRT 治疗的临床分期 I 至 III 期胃腺癌患者。选择获得 cPR 的患者。采用 Mann-Whitney U 检验和 Fisher 确切检验评估相关性。采用标准 Kaplan-Meier 方法总结生存信息，使用 95%置信区间估计中位和 5 年生存率。
共确定 413 例获得 cPR 的患者。84 例患者接受 nCT，329 例患者接受 nCRT。nCRT 组患者临床分期更高（88.4% vs. 75.0%），肿瘤位置更靠近近端（95.4% vs. 45.2%）。nCT 组（n=84）的 5 年生存率为 94%，而 nCRT 组（n=329）的生存率为 60%（p<0.001）。采用倾向评分加权法的 Cox 回归模型，nCT 治疗是总生存改善的独立预测因素（nCRT 与 nCT；HR 10.44，p<0.001）。
在胃腺癌获得 cPR 的患者中，与 nCRT 相比，nCT 可显著提高总体生存率。虽然本研究在确定总体生存率差异的原因方面存在局限性，但这一重要发现仍需要进一步研究，并应在未来胃癌试验的开展中予以考虑。
