Wang Tong-Bo, Zhou Hong, Zhang Xiao-Jie, Sun Chong-Yuan, Guo Chun-Guang, Chen Ying-Tai, Zhou Ai-Ping, Jin Jing, Zhao Dong-Bing
Department of Pancreatic and Gastric Surgical Oncology,Beijing 100021,China.
Department of Medical Oncology,Beijing 100021,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2021 Aug;43(4):571-578. doi: 10.3881/j.issn.1000-503X.13260.
Objective To investigate the related factors of pathological complete response(pCR)of patients with gastric cancer treated by neoadjuvant therapy and resection,and to analyze the risk factors of prognosis. Methods The clinical and pathological data of 490 patients with gastric cancer who received neoadjuvant therapy followed by radical gastrectomy from January to December in 2008 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify the risk factors affecting pCR and prognosis. Results Among the 490 patients,41 achieved pCR,and the overall pCR rate was 8.3%(41/490).The pCR rate was 16.0% in the neoadjuvant chemoradiation group and 6.4% in the neoadjuvant chemotherapy group.The results of multivariate analysis showed that neoadjuvant chemoradiation(=4.401,95% =2.023-9.574,<0.001)and preoperative therapeutic response as partial response(=40.492,95% =5.366-305.572,<0.001)were independent predictors of pCR after neoadjuvant therapy.Multivariate analysis of prognosis showed that poorly differentiated tumor(=1.809,95% =1.104-2.964,=0.019),gastric cardia-fundus-body tumor(=2.025,95% =1.497-2.739,<0.001),≤15 intraoperative dissected lymph nodes(=1.482,95% =1.059-2.073,=0.022),and postoperative complications(=1.625,95% =1.156-2.285,=0.005)were independent risk factors for prognosis,while pCR(=0.153,95% =0.048-0.484,=0.001)and postoperative adjuvant chemotherapy(=0.589,95% =0.421-0.823,<0.001)were independent protective factors of prognosis. Conclusions Patients who achieved pCR after neoadjuvant therapy for locally advanced gastric cancer might have promising long-term survival,and pCR is an independent predictor for overall survival.Compared with chemotherapy alone,preoperative chemoradiotherapy can significantly improve the pCR rate of patients with locally advanced gastric cancer.
目的 探讨新辅助治疗后行手术切除的胃癌患者病理完全缓解（pCR）的相关因素，并分析预后的危险因素。方法 回顾性分析2008年1月至12月期间490例行新辅助治疗后接受根治性胃切除术的胃癌患者的临床和病理资料。进行单因素和多因素分析以确定影响pCR和预后的危险因素。结果 490例患者中，41例达到pCR，总体pCR率为8.3%（41/490）。新辅助放化疗组的pCR率为16.0%，新辅助化疗组为6.4%。多因素分析结果显示，新辅助放化疗（=4.401，95% =2.023 - 9.574，<0.001）和术前治疗反应为部分缓解（=40.492，95% =5.366 - 305.572，<0.001）是新辅助治疗后pCR的独立预测因素。预后的多因素分析显示，肿瘤低分化（=1.809，95% =1.104 - 2.964，=0.019）、胃贲门 - 胃底 - 胃体部肿瘤（=2.025，95% =1.497 - 2.739，<0.001）、术中清扫淋巴结≤15枚（=1.482，95% =1.059 - 2.073，=0.022）及术后并发症（=1.625，95% =1.156 - 2.285，=0.005）是预后的独立危险因素，而pCR（=0.153，95% =0.048 - 0.484，=0.001）和术后辅助化疗（=0.589，95% =0.421 - 0.823，<0.001）是预后的独立保护因素。结论 局部进展期胃癌新辅助治疗后达到pCR的患者可能有较好的长期生存，且pCR是总生存的独立预测因素。与单纯化疗相比，术前放化疗可显著提高局部进展期胃癌患者的pCR率。
