Schirren Rebekka, Novotny Alexander, Friess Helmut, Reim Daniel
TUM School of Medicine, Department of Surgery, Ismaninger Strasse 22, 81675 Munich, Germany.
Cancers (Basel). 2020 Aug 11;12(8):2244. doi: 10.3390/cancers12082244.
There is conflicting evidence regarding the efficacy of neoadjuvant/perioperative chemotherapy (NCT) for gastro-esophageal cancer (GEC) on overall survival. This study aimed to analyze the outcomes of multimodal treatments in a large single center cohort. We performed a retrospective analysis of patients treated with NCT, followed by intended curative oncological surgery for locally advanced gastric cancer. Uni- and multivariate regression analysis were performed to identify the predictors of overall survival. From over 3000 patients, 702 eligible patients were analyzed. In the univariate analysis clinical stage, application of preoperative PLF, requirement of surgical extension, UICC-stage, grading, R-status, Lauren histotype, and HPR were the prognostic survival factors. In multivariate analysis PLF regimen, UICC-stages, R-status, Lauren histotype, and histopathologic regression (HPR) were significant predictors of overall survival. Overall HPR-rate was 26.9%. HPR was highest in the cT2cN0 stage (55.9%), and lowest in the cT3/4 cN+ stage (21.6%). FLOT demonstrated the highest HPR (37.5%). Independent predictors for HPR were the clinical stage and grading. Kaplan Meier analyses demonstrated significant survival benefits for the responding patients ( < 0.0001). HPR after NCT was an important prognostic factor to predict overall survival for locally advanced GEC. FLOT should be the preferred regimen in patients undergoing NCT ahead of surgery.
关于新辅助/围手术期化疗（NCT）对胃食管癌（GEC）总生存期的疗效，存在相互矛盾的证据。本研究旨在分析一个大型单中心队列中多模式治疗的结果。我们对接受NCT治疗的患者进行了回顾性分析，随后对局部晚期胃癌进行了意向性根治性肿瘤手术。进行单因素和多因素回归分析以确定总生存期的预测因素。从3000多名患者中，分析了702例符合条件的患者。单因素分析中，临床分期、术前PLF的应用、手术扩大范围的需求、UICC分期、分级、R状态、Lauren组织学类型和组织病理学退缩（HPR）是预后生存因素。多因素分析中，PLF方案、UICC分期、R状态、Lauren组织学类型和组织病理学退缩（HPR）是总生存期的重要预测因素。总体HPR率为26.9%。HPR在cT2cN0期最高（55.9%），在cT3/4 cN+期最低（21.6%）。FLOT方案的HPR最高（37.5%）。HPR的独立预测因素是临床分期和分级。Kaplan Meier分析显示，反应性患者有显著的生存获益（<0.0001）。NCT后的HPR是预测局部晚期GEC总生存期的重要预后因素。对于术前接受NCT的患者，FLOT应是首选方案。
