Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujin, Dongcheng District, Beijing, 100730, China.
Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China.
World J Surg Oncol. 2021 Feb 9;19(1):44. doi: 10.1186/s12957-021-02157-x.
Neoadjuvant chemotherapy is an important part of the comprehensive treatment of advanced gastric cancer (GC). The effect of neoadjuvant chemotherapy plays a key role in the prognosis of GC patients. Pathological response can represent the effect of neoadjuvant chemotherapy. However, evidence focused on pathological response and associated clinicopathological factors in GC patients is quite little. In this retrospective study, the clinicopathological factors affecting the effect of neoadjuvant chemotherapy in GC patients were investigated, and suggestions were proposed to improve the effect of neoadjuvant chemotherapy on GC.
Retrospective analysis was performed on GC patients who received radical surgery after neoadjuvant chemotherapy from February 2016 to December 2019 at Peking Union Medical College Hospital. Relevant clinicopathological data was collected to analyze the factors influencing the effect of neoadjuvant chemotherapy. Chi-square test was used for univariate analysis. Logistic regression was used for multivariate analysis. Receiver operating characteristic curve (ROC) was used to determine the cutoff value of variables which significantly influenced the effect of neoadjuvant chemotherapy.
A total of 203 GC patients were included in the study. Analyses showed that patients < 60 years old (OR = 1.840 [1.016-3.332], P = 0.044), histological type of poor differentiation or signet-ring cell carcinoma (OR = 2.606 [1.321-5.140], P = 0.006), and weight loss during neoadjuvant chemotherapy (OR = 2.110 [1.161-3.834], P = 0.014) were independent risk factors for neoadjuvant chemotherapy effect. In ROC analysis of weight change and neoadjuvant chemotherapy effect, area under the curve (AUC) was 0.593 (P = 0.024) and cutoff value of weight change was - 2.95%. Chi-square test showed that patients without weight loss during neoadjuvant chemotherapy had a higher rate of oral nutritional supplement (ONS) than patients with weight loss (P = 0.039).
Patients <60 years old, histological type of poor differentiation or signet-ring cell carcinoma, and weight loss during neoadjuvant chemotherapy were independent risk factors for neoadjuvant chemotherapy effect in GC patients. Patients with weight loss > 2.95% during neoadjuvant may have a worse chemotherapy effect. Timely nutritional support such as ONS to maintain patients' body weight is crucial for improving the effect of neoadjuvant chemotherapy.
新辅助化疗是晚期胃癌（GC）综合治疗的重要组成部分。新辅助化疗的效果对 GC 患者的预后起着关键作用。病理缓解可以代表新辅助化疗的效果。然而，目前针对 GC 患者的病理缓解及其相关临床病理因素的证据相当有限。在这项回顾性研究中，我们调查了影响 GC 患者新辅助化疗效果的临床病理因素，并提出了改善 GC 患者新辅助化疗效果的建议。
对 2016 年 2 月至 2019 年 12 月在我院接受新辅助化疗后行根治性手术的 GC 患者进行回顾性分析。收集相关临床病理资料，分析影响新辅助化疗效果的因素。采用卡方检验进行单因素分析，采用 logistic 回归进行多因素分析。采用受试者工作特征曲线（ROC）确定对新辅助化疗效果有显著影响的变量的截断值。
本研究共纳入 203 例 GC 患者。分析表明，年龄<60 岁（OR=1.840[1.016-3.332]，P=0.044）、组织学类型为低分化或印戒细胞癌（OR=2.606[1.321-5.140]，P=0.006）和新辅助化疗期间体重减轻（OR=2.110[1.161-3.834]，P=0.014）是新辅助化疗效果的独立危险因素。在体重变化与新辅助化疗效果的 ROC 分析中，曲线下面积（AUC）为 0.593（P=0.024），体重变化的截断值为-2.95%。卡方检验显示，新辅助化疗期间无体重减轻的患者口服营养补充（ONS）的比例高于体重减轻的患者（P=0.039）。
年龄<60 岁、组织学类型为低分化或印戒细胞癌、新辅助化疗期间体重减轻是 GC 患者新辅助化疗效果的独立危险因素。新辅助化疗期间体重减轻>2.95%的患者可能化疗效果较差。及时给予 ONS 等营养支持以维持患者体重对提高新辅助化疗效果至关重要。
