Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou, 510-515, China.
BMC Cancer. 2021 Feb 25;21(1):196. doi: 10.1186/s12885-021-07919-0.
The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy.
This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined.
There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1-/3-/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1-/3-/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357-0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322-0.811, P = 0.004) in stage III patients.
This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.
由于大多数临床试验中老年人代表性不足，辅助化疗对老年胃癌（GC）患者的益处仍不清楚。本研究旨在评估腹腔镜 D2 胃切除术后 >65 岁患者辅助化疗的有效性和并发症。
这是一项单中心回顾性队列研究，纳入了 2004 年至 2018 年间接受腹腔镜 D2 胃切除术且 R0 切除的 II/III 期 GC 老年患者（>65 岁）。辅助化疗方案包括单药治疗（口服卡培他滨）和联合化疗（口服卡培他滨加静脉奥沙利铂[XELOX]或静脉奥沙利铂、亚叶酸和 5-氟尿嘧啶[FOLFOX]）。数据从中国南方医院普外科前瞻性注册数据库中检索。患者分为单纯手术组和手术加辅助化疗（化疗组）。检查总生存（OS）、无病生存（DFS）、化疗持续时间和毒性。
共纳入 270 例患者：手术组 169 例，化疗组 101 例。有 10 例（10/101）和 6 例（6/101）患者出现 3+ 级非血液学和血液学不良事件。手术组的 1/3/5 年 OS 率分别为 72.9%/51.8%/48.3%，化疗组分别为 90.1%/66.4%/48.6%（对数秩检验：P=0.018）。对于 III 期患者，手术组的 1/3/5 年 OS 率分别为 83.7%/40.7%/28.7%，化疗组分别为 89.9%/61.2%/43.6%（对数秩检验：P=0.015）。辅助化疗与 III 期患者的更高 OS（HR=0.568，95%CI：0.357-0.903，P=0.017）和 DFS（HR=0.511，95%CI：0.322-0.811，P=0.004）显著相关。
本研究表明，与单纯手术相比，腹腔镜 D2 胃切除术后辅助化疗可显著提高 III 期老年 GC 患者的 OS 和 DFS，且不良事件谱可耐受。
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