Wu Siyi, Chu Yuxin, Hu Qinyong, Song Qibin
Department of Oncology I, Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China.
Transl Cancer Res. 2020 Nov;9(11):6929-6938. doi: 10.21037/tcr-20-1750.
The role of adjuvant radiotherapy (RT) in gastric cancer (GC) patients has not been well-established. This study initiated a retrospective case-control study to explore the survival impact of adjuvant RT on these patients.
All patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The cohort was assigned into patients without adjuvant RT versus those with adjuvant RT. Descriptive chi-square test was adopted to compare categorical variates between the 2 groups. Kaplan-Meier (KM) method was adopted to estimate the patients' cancer-specific survival (CSS) and overall survival (OS). Cox proportional hazard models were utilized to characterize the prognostic factors of their CSS.
Totally 7,194 patients were recruited in this study, 3,326 (46.2%) patients didn't have RT and 3,868 (53.8%) patients had adjuvant RT. Survival analysis of the entire population showed that adjuvant RT had remarkable survival benefits for the GC patients. The median CSS was 47.0 (42.0-52.0) months in RT group versus 32.0 (29.7-34.3) months in no RT group (P<0.001). Age >60, histologic type 8490, tumor size >50 mm, higher stage TNM, and surgery type 40/50 were independent risk factors for poor prognosis. Comparatively, adjuvant RT and LN examined >0 were independent factors for improving prognosis. Subgroup analysis demonstrated that adjuvant RT had significant survival benefits for patients with 1-14 and 15-29 lymph nodes (LNs) retrieved.
Adjuvant radiotherapy may have significant survival benefits for GC patients with 1-29 LNs retrieved. Our study upholds adjuvant RT for this subset of patients.
辅助放疗（RT）在胃癌（GC）患者中的作用尚未完全明确。本研究开展了一项回顾性病例对照研究，以探讨辅助放疗对这些患者生存的影响。
所有患者均来自监测、流行病学和最终结果（SEER）数据库。该队列被分为未接受辅助放疗的患者和接受辅助放疗的患者。采用描述性卡方检验比较两组之间的分类变量。采用Kaplan-Meier（KM）方法估计患者的癌症特异性生存（CSS）和总生存（OS）。利用Cox比例风险模型确定其CSS的预后因素。
本研究共纳入7194例患者，3326例（46.2%）患者未接受放疗，3868例（53.8%）患者接受了辅助放疗。对整个人群的生存分析表明，辅助放疗对GC患者具有显著的生存益处。放疗组的中位CSS为47.0（42.0 - 52.0）个月，未放疗组为32.0（29.7 - 34.3）个月（P<0.001）。年龄>60岁、组织学类型8490、肿瘤大小>50 mm、更高的TNM分期和手术类型40/50是预后不良的独立危险因素。相比之下，辅助放疗和检出淋巴结>0个是改善预后的独立因素。亚组分析表明，辅助放疗对检出1 - 14个和15 - 29个淋巴结（LNs）的患者具有显著的生存益处。
对于检出1 - 29个LNs的GC患者，辅助放疗可能具有显著的生存益处。我们的研究支持对这部分患者进行辅助放疗。
