Xu Wei, Wang Lingquan, Yan Chao, He Changyu, Lu Sheng, Ni Zhentian, Hua Zichen, Zhu Zhenglun, Sah Birendra Kumar, Yang Zhongyin, Zheng Yanan, Feng Runhua, Li Chen, Yao Xuexin, Chen Mingmin, Liu Wentao, Yan Min, Zhu Zhenggang
Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2021 Aug 23;11:718556. doi: 10.3389/fonc.2021.718556. eCollection 2021.
For locally advanced gastric cancer (LAGC) with serosal invasion (cT4NxM0), adjuvant chemotherapy (AC) after D2 gastrectomy is the standard therapy in Asia. However, perioperative chemotherapy (PCT) combined with D2 gastrectomy is mostly suggested in Europe and America. As a part of PCT, the value of neoadjuvant chemotherapy (NAC) is unclear. We investigated whether NAC could further improve survival and other outcomes for these patients.
Patients with cT4NxM0 gastric cancer who underwent D2 gastrectomy were analyzed. The patients were divided into two groups based on whether they received NAC: the neoadjuvant chemotherapy (NAC) and direct surgery (S) groups. After propensity score matching (1:1 ratio), survival and perioperative outcomes were analyzed between the two groups.
A total of 902 patients met all the eligibility criteria and were enrolled. After propensity score matching, 221 matched pairs of patients were identified. The median overall survival (OS) and disease-free survival (DFS) of all patients were 75.10 and 43.67 months, respectively. The median OS of patients in the NAC and S groups were undefined and 29.80 months, respectively (P<0.0001). The median DFS of patients in the NAC and S groups were undefined and 22.60 months (P<0.0001). There were no significant differences in the radical degrees of operation between the two groups (P=0.07). However, there were significant differences in postoperative hospital stay (P<0.001) and complications (P=0.037) between the two groups.
This study suggested NAC can further improve prognosis and prevent recurrence in LAGC (cT4NxM0) patients. NAC is feasible and safe for LAGC (cT4NxM0) patients, and does not increase the risk of perioperative surgery.
对于伴有浆膜侵犯（cT4NxM0）的局部进展期胃癌（LAGC），D2 胃切除术后辅助化疗（AC）是亚洲的标准治疗方法。然而，欧美地区大多建议采用围手术期化疗（PCT）联合 D2 胃切除术。作为 PCT 的一部分，新辅助化疗（NAC）的价值尚不明确。我们研究了 NAC 是否能进一步改善这些患者的生存率和其他结局。
对接受 D2 胃切除术的 cT4NxM0 胃癌患者进行分析。根据是否接受 NAC 将患者分为两组：新辅助化疗（NAC）组和直接手术（S）组。在倾向评分匹配（1:1 比例）后，分析两组之间的生存率和围手术期结局。
共有 902 例患者符合所有入选标准并被纳入研究。经过倾向评分匹配后，确定了 221 对匹配患者。所有患者的中位总生存期（OS）和无病生存期（DFS）分别为 75.10 个月和 43.67 个月。NAC 组和 S 组患者的中位 OS 分别为未定义和 29.80 个月（P<0.0001）。NAC 组和 S 组患者的中位 DFS 分别为未定义和 22.60 个月（P<0.0001）。两组之间手术根治程度无显著差异（P = 0.07）。然而，两组之间术后住院时间（P<0.001）和并发症（P = 0.037）存在显著差异。
本研究表明，NAC 可进一步改善 LAGC（cT4NxM0）患者的预后并预防复发。NAC 对于 LAGC（cT4NxM0）患者是可行且安全的，并且不会增加围手术期手术风险。
