Division of Surgical Oncology, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
Surg Oncol. 2020 Sep;34:134-139. doi: 10.1016/j.suronc.2020.04.010. Epub 2020 Apr 7.
In the ARTIST trial, chemoradiation did not improve disease-free survival (DFS) in gastric cancer patients treated with curative-intent surgery and adjuvant chemotherapy. Subgroup analysis suggested chemoradiation improved DFS in patients with lymph node (LN) metastases, but the role of adjuvant chemoradiation remains uncertain. This study sought to determine the role of adjuvant chemoradiation using population-based methods.
Surveillance, Epidemiology and End Results-Medicare linked data from 2004 to 2013 was used to identify patients aged 66 and older with LN-positive gastric adenocarcinoma. Multivariable logistic regression evaluated factors associated with receipt of chemoradiation. The Kaplan-Meier method and Cox proportional hazards modeling were used to evaluate overall survival (OS).
A total of 2409 patients with LN-positive gastric adenocarcinoma who underwent upfront surgical resection were identified; 309 (13%) received adjuvant chemotherapy and 407 (17%) received adjuvant chemotherapy and chemoradiation. Among all patients, median OS was 15 months. Median OS was 20 months for patients who received chemotherapy alone and 27 months for patients who received chemotherapy and chemoradiation (p < 0.05). Recent diagnosis, older age, tumor stage T3 or T4, and Charleston Comorbidity Index were associated with an increased hazard ratio for death (p < 0.05). Receipt of chemoradiation was associated with a decreased hazard ratio for death (p < 0.05).
In patients with LN-positive gastric adenocarcinoma, the addition of chemoradiation to adjuvant chemotherapy after upfront surgical resection was associated with improved survival irrespective of the extent of lymphadenectomy. These data suggest chemoradiation should be considered in patients with LN-positive gastric adenocarcinoma.
在 ARTIST 试验中，接受根治性手术和辅助化疗的胃癌患者，放化疗并未改善无病生存（DFS）。亚组分析表明，放化疗改善了有淋巴结（LN）转移的患者的 DFS，但辅助放化疗的作用仍不确定。本研究旨在采用基于人群的方法确定辅助放化疗的作用。
使用 2004 年至 2013 年监测、流行病学和最终结果-医疗保险数据，确定 LN 阳性胃腺癌年龄在 66 岁及以上的患者。多变量逻辑回归评估与接受放化疗相关的因素。Kaplan-Meier 方法和 Cox 比例风险模型用于评估总生存期（OS）。
共确定了 2409 例接受 LN 阳性胃腺癌初始手术切除的患者；309 例（13%）接受辅助化疗，407 例（17%）接受辅助化疗和放化疗。所有患者的中位 OS 为 15 个月。单独接受化疗的患者中位 OS 为 20 个月，而接受化疗和放化疗的患者中位 OS 为 27 个月（p<0.05）。最近诊断、年龄较大、肿瘤分期 T3 或 T4 以及 Charlson 合并症指数与死亡风险比增加相关（p<0.05）。接受放化疗与死亡风险比降低相关（p<0.05）。
在 LN 阳性胃腺癌患者中，与单独接受辅助化疗相比，在初始手术切除后加用放化疗可改善生存，无论淋巴结清扫范围如何。这些数据表明，对于 LN 阳性胃腺癌患者，应考虑放化疗。
