对于老年 II 期胃癌患者，与开腹胃癌根治术相比，术前良好的免疫预后指数可预测腹腔镜胃癌根治术后的长期预后更好。
A good preoperative immune prognostic index is predictive of better long-term outcomes after laparoscopic gastrectomy compared with open gastrectomy for stage II gastric cancer in elderly patients.
机构信息
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian, China.
出版信息
Surg Endosc. 2022 Mar;36(3):1814-1826. doi: 10.1007/s00464-021-08461-7. Epub 2021 Jun 2.
BACKGROUND
It remains inconclusive whether laparoscopic gastrectomy (LG) has better long-term outcomes when compared with open gastrectomy (OG) for elderly gastric cancer (EGC). We attempted to explore the influence of the immune prognostic index (IPI) on the prognosis of EGCs treated by LG or OG to identify a population among EGC who may benefit from LG.
METHODS
We included 1539 EGCs treated with radical gastrectomy from January 2007 to December 2016. Propensity score matching was applied at a ratio of 1:1 to compare the LG and OG groups. The IPI based on dNLR ≥ cut-off value (dNLR) and sLDH ≥ cut-off value (sLDH) was developed, characterizing two groups (IPI = 0, good, 0 factors; IPI = 1, poor, 1 or 2 factors).
RESULTS
Of the 528 EGCs (LG: 264 and OG: 264), 271 were in the IPI = 0 group, and 257 were in the IPI = 1 group. In the entire cohort, the IPI = 0 group was associated with good 5-year overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.003) compared to the IPI = 1 group; no significant differences in 5-year OS and PFS between the LG and OG groups were observed. In the IPI = 1 cohort, there was no significant difference in OS or PFS between the LG and OG groups across all tumor stages. However, in the IPI = 0 cohort, LG was associated with longer OS (p = 0.015) and PFS (p = 0.018) than OG in stage II EGC, but not in stage I or III EGC. Multivariate analysis showed that IPI = 0 was an independent protective factor for stage II EGC receiving LG, but not for those receiving OG.
CONCLUSION
The IPI is related to the long-term prognosis of EGC. Compared with OG, LG may improve the 5-year survival rate of stage II EGC with a good IPI score. This hypothesis needs to be further confirmed by prospective studies.
背景
腹腔镜胃切除术（LG）与开腹胃切除术（OG）治疗老年胃癌（EGC）的长期结果孰优孰劣，目前尚无定论。我们试图探讨免疫预后指数（IPI）对 LG 或 OG 治疗 EGC 预后的影响，以确定可能从 LG 中获益的 EGC 人群。
方法
我们纳入了 2007 年 1 月至 2016 年 12 月接受根治性胃切除术的 1539 例 EGC 患者。采用 1:1 比例的倾向评分匹配比较 LG 和 OG 组。根据 dNLR≥临界值（dNLR）和 sLDH≥临界值（sLDH）建立 IPI（dNLR 临界值定义为 2.6，sLDH 临界值定义为 240 U/L），特征为两组（IPI=0，良好，0 个因素；IPI=1，不良，1 或 2 个因素）。
结果
在 528 例 EGC 患者（LG：264 例，OG：264 例）中，271 例患者 IPI=0，257 例患者 IPI=1。在整个队列中，与 IPI=1 组相比，IPI=0 组患者 5 年总生存率（OS）（p=0.001）和无进展生存率（PFS）（p=0.003）更好；LG 和 OG 两组间 5 年 OS 和 PFS 无显著差异。在 IPI=1 队列中，各肿瘤分期中 LG 和 OG 两组间 OS 或 PFS 无显著差异。然而，在 IPI=0 队列中，LG 与 stage II EGC 的 OS（p=0.015）和 PFS（p=0.018）的延长相关，而与 stage I 或 III EGC 无关。多因素分析显示，IPI=0 是接受 LG 治疗的 stage II EGC 的独立保护因素，但不是接受 OG 治疗的保护因素。
结论
IPI 与 EGC 的长期预后相关。与 OG 相比，LG 可能提高 IPI 评分良好的 stage II EGC 的 5 年生存率。这一假设需要前瞻性研究进一步证实。
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