Department of Surgery, 6614University of Pittsburgh, PA, USA.
Am Surg. 2021 Jul;87(7):1145-1154. doi: 10.1177/0003134820972083. Epub 2020 Dec 19.
With advances in multimodal therapy, survival rates in gastric cancer have significantly improved over the last two decades. Neoadjuvant therapy increases the likelihood of achieving negative margins and may even lead to pathologic complete response (pCR). However, the impact of pCR on survival in gastric cancer has been poorly described. We analyzed the rate and predictors of pCR in patients receiving neoadjuvant therapy as well as impact of pCR on survival.
We conducted a National Cancer Database (NCDB) analysis (2004-2016) of patients with gastric adenocarcinoma who received neoadjuvant chemotherapy followed by surgical resection.
The pCR rate was 2.2%. Following adjustment, only neoadjuvant chemoradiation, non-signet histology, and tumor grade remained as significant factors predicting pCR. pCR was a statistically significant predictor of survival.
In this NCDB study, pCR was a predictor of survival. Though chemoradiation rather than chemotherapy alone was a predictor of pCR, it was not a predictor of survival. Further studies are needed to elucidate the role of radiation in the neoadjuvant setting and to discern the impact of pCR on survival.
随着多模态治疗的进步，过去二十年来胃癌的生存率有了显著提高。新辅助治疗增加了获得阴性切缘的可能性，甚至可能导致病理完全缓解（pCR）。然而，pCR 对胃癌患者生存的影响描述得并不充分。我们分析了接受新辅助治疗的患者中 pCR 的发生率和预测因素，以及 pCR 对生存的影响。
我们对接受新辅助化疗后行手术切除的胃腺癌患者进行了国家癌症数据库（NCDB）分析（2004-2016 年）。
pCR 率为 2.2%。调整后，只有新辅助放化疗、非印戒细胞组织学和肿瘤分级仍然是预测 pCR 的显著因素。pCR 是生存的统计学显著预测因素。
在这项 NCDB 研究中，pCR 是生存的预测因素。虽然放化疗而不是单纯化疗是 pCR 的预测因素，但它不是生存的预测因素。需要进一步的研究来阐明放射在新辅助治疗中的作用，并阐明 pCR 对生存的影响。
