Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China.
BMC Cancer. 2021 Jul 3;21(1):771. doi: 10.1186/s12885-021-08534-9.
Due to negative results in clinical trials of postoperative chemoradiation for gastric cancer, at present, there is a tendency to move chemoradiation therapy forward in gastric and gastroesophageal junction (GEJ) adenocarcinoma. Several randomized controlled trials (RCTs) are currently recruiting subjects to investigate the effect of neo-adjuvant radiotherapy (NRT) in gastric and GEJ cancer. Large retrospective studies may be beneficial in clarifying the potential benefit of NRT, providing implications for RCTs.
We retrieved the clinicopathological and treatment data of gastric and GEJ adenocarcinoma patients who underwent surgical resection and chemotherapy between 2004 and 2015 from Surveillance, Epidemiology, and End Results (SEER) database. We compared survival between NRT and non-NRT patients among four clinical subgroups (TN, TN, TN, and TN).
Overall, 5272 patients were identified, among which 1984 patients received NRT. After adjusting confounding variables, significantly improved survival between patients with and without NRT was only observed in TN subgroup [hazard ratio (HR) 0.79, 95% confidence interval (CI): 0.66-0.95; P = 0.01]. Besides, Kaplan-Meier plots showed significant cause-specific survival advantage of NRT in intestinal type (P < 0.001), but not in diffuse type (P = 0.11) for TN patients. In the multivariate competing risk model, NRT still showed survival advantage only in T N patients (subdistribution HR: 0.77; 95% CI: 0.64-0.93; P = 0.006), but not in other subgroups.
NRT might benefit resectable gastric and GEJ cancer patients of T3-4 stages with positive lymph nodes, particularly for intestinal-type. Nevertheless, these results should be interpreted with caution, and more data from ongoing RCTs are warranted.
由于胃癌术后放化疗的临床试验结果为阴性，目前，胃和胃食管交界处（GEJ）腺癌的放化疗治疗有前移的趋势。目前有几项随机对照试验（RCT）正在招募受试者，以研究新辅助放疗（NRT）在胃和 GEJ 癌中的作用。大型回顾性研究可能有助于阐明 NRT 的潜在益处，并为 RCT 提供启示。
我们从监测、流行病学和最终结果（SEER）数据库中检索了 2004 年至 2015 年间接受手术切除和化疗的胃和 GEJ 腺癌患者的临床病理和治疗数据。我们比较了 NRT 和非 NRT 患者在四个临床亚组（TN、TN、TN 和 TN）中的生存情况。
共纳入 5272 例患者，其中 1984 例接受 NRT。在调整混杂变量后，仅在 TN 亚组中观察到 NRT 组和非 NRT 组之间的生存有显著改善[风险比（HR）0.79，95%置信区间（CI）：0.66-0.95；P=0.01]。此外，Kaplan-Meier 生存曲线显示，NRT 在肠型 TN 患者中具有显著的特异性生存优势（P<0.001），而在弥漫型 TN 患者中则无此优势（P=0.11）。在多变量竞争风险模型中，NRT 仅在 T N 患者中仍显示生存优势（亚分布 HR：0.77；95%CI：0.64-0.93；P=0.006），而在其他亚组中则无此优势。
NRT 可能使 T3-4 期伴阳性淋巴结的可切除胃和 GEJ 癌患者受益，特别是肠型患者。然而，这些结果应谨慎解释，需要更多来自正在进行的 RCT 的数据。
