Xu Wei, Fan Zhiyuan, Wang Lingquan, He Changyu, Ni Zhentian, Hua Zichen, Zhu Zhenglun, Yang Zhongyin, Zheng Yanan, Feng Runhua, Yan Chao, Li Chen, Yao Xuexin, Chen Mingmin, Yan Min, Zhu Zhenggang, Liu Wentao
Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai 200025, China.
Am J Transl Res. 2021 Mar 15;13(3):1568-1579. eCollection 2021.
Neoadjuvant chemotherapy (NAC) plays an important role in the therapeutic strategy of locally advanced gastric cancer (LAGC). However, the response of LAGC after NAC varies among different patients. The objective response after NAC has proven to be an excellent indicator for benefiting from NAC, yet effective predictors of objective response are still lacking. The present study aimed to identify potential predictors of objective response in LAGC patients treated with NAC.
Clinicopathological data from 267 patients with LAGC who received NAC and met the inclusion criteria between July 2009 and December 2018 were retrospectively reviewed. Patients were randomly divided into the training and test sets at a 2:1 ratio. Univariate analysis was used to investigate whether any factors were correlated with objective response in the training set. Multivariate logistic regression analysis was applied to find independent predictors. A risk score model was then constructed based on the independent predictors, and its performance in predicting objective response was validated in the test set.
Univariate analysis found that gender, age, short axis diameter of the largest regional lymph node (LN), serum total protein content, CEA detection value, tumor location, tumor differentiation, signet ring cell carcinoma component and Borrmann type were potential predictors for objective response. In multivariate logistic regression analysis, gender, LN and signet ring cell carcinoma component were independent predictors for objective response. Based on independent predictors, we developed a prediction model for objective response.
We found gender, LN and signet ring cell carcinoma component were independent predictors for objective response. The prediction model is a good tool to predict the objective response for LAGC patients treated with NAC, which can be applied to guide clinical practice.
新辅助化疗（NAC）在局部晚期胃癌（LAGC）的治疗策略中起着重要作用。然而，NAC 后 LAGC 患者的反应在不同患者之间存在差异。NAC 后的客观反应已被证明是从 NAC 中获益的一个极佳指标，但仍缺乏客观反应的有效预测因子。本研究旨在确定接受 NAC 治疗的 LAGC 患者客观反应的潜在预测因子。
回顾性分析 2009 年 7 月至 2018 年 12 月期间 267 例接受 NAC 且符合纳入标准的 LAGC 患者的临床病理资料。患者按 2:1 的比例随机分为训练集和测试集。采用单因素分析研究训练集中是否有任何因素与客观反应相关。应用多因素逻辑回归分析寻找独立预测因子。然后基于独立预测因子构建风险评分模型，并在测试集中验证其预测客观反应的性能。
单因素分析发现，性别、年龄、最大区域淋巴结（LN）短轴直径、血清总蛋白含量、CEA 检测值、肿瘤位置、肿瘤分化、印戒细胞癌成分和 Borrmann 分型是客观反应的潜在预测因子。在多因素逻辑回归分析中，性别、LN 和印戒细胞癌成分是客观反应的独立预测因子。基于独立预测因子，我们建立了客观反应的预测模型。
我们发现性别、LN 和印戒细胞癌成分是客观反应的独立预测因子。该预测模型是预测接受 NAC 治疗的 LAGC 患者客观反应的良好工具，可应用于指导临床实践。
