Zhao Lulu, Ling Rui, Ma Fuhai, Ren Hu, Zhou Hong, Wang Tongbo, Chen Yingtai, Hu Shangying, Zhao Dongbing
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Microbiology and Immunology, Georgetown University Medical Center, Washington, DC, USA.
Transl Cancer Res. 2020 Apr;9(4):2769-2779. doi: 10.21037/tcr.2020.02.38.
The safety and efficacy of proximal gastrectomy (PG) following for locally advanced proximal gastric cancer (LAPGC) were unclear, as oncologic outcomes of randomized trials are still pending. The aim of this study was to evaluate surgical results and long-term oncologic outcomes of PG versus total gastrectomy (TG) in treating locally advanced gastric cancer (LAGC).
A total of 2,918 LAPGC patients with PG or TG were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) 1998-2018. Propensity score matching was employed to match patients with PG or TG in a 1:1 ratio. Surgery outcomes and overall survival (OS) rates were compared between PG and TG groups after the propensity-score match. Cox proportional hazards model was used to explore the risk factors for OS.
Of 2,918 patients, 181 (6.20%) underwent TG, while 2,737 (93.80%) underwent PG. After propensity score matching, 150 matched pairs for PG and TG were selected. Compared with TG group, PG group had shorter operative time (181.8±49.8 213.5±66.7 min, P<0.001) and less estimated blood transfusion (10.00% 22.67%, P=0.001). More lymph nodes (34.3±17.0 24.2±11.0, P<0.001) were retrieved in TG group than in PG group. The 3- and 5-year OS rates (79.1% 77.2% and 74.5% 72.0%, respectively, both P<0.001) in PG group were slightly higher than ones in TG group. However, the multivariable results showed that there was no significant difference in the OS status between the two groups (HR: 1.172, 95% CI: 0.916-1.499, P=0.208), even stratified into stage II and III subgroup.
In conclusion, the extent of resection for LAPGC patients did not influence the long-term survival outcomes. Moreover, future randomized clinical trials of quality of life following PG or TG are expected to assist surgeons in the choice of surgical approach and strategy for LAPGC patients.
对于局部进展期近端胃癌（LAPGC），近端胃切除术（PG）的安全性和有效性尚不清楚，因为随机试验的肿瘤学结果仍未明确。本研究的目的是评估PG与全胃切除术（TG）在治疗局部进展期胃癌（LAGC）方面的手术结果和长期肿瘤学结果。
从中国国家癌症中心胃癌数据库（NCCGCDB）1998 - 2018年中识别出2918例接受PG或TG的LAPGC患者。采用倾向评分匹配法以1:1的比例匹配接受PG或TG的患者。在倾向评分匹配后，比较PG组和TG组的手术结果和总生存率（OS）。使用Cox比例风险模型探索OS的危险因素。
在2918例患者中，181例（6.20%）接受了TG，而2737例（93.80%）接受了PG。倾向评分匹配后，选择了150对PG和TG的匹配对。与TG组相比，PG组手术时间更短（181.8±49.8对213.5±66.7分钟，P<0.001），估计输血量更少（10.00%对22.67%，P = 0.001）。TG组切除的淋巴结比PG组更多（34.3±17.0对24.2±11.0，P<0.001）。PG组的3年和5年OS率（分别为79.1%对77.2%和74.5%对72.0%，P均<0.001）略高于TG组。然而，多变量结果显示两组的OS状态无显著差异（HR：1.172，95%CI：0.916 - 1.499，P = 0.208），即使分为II期和III期亚组也是如此。
总之，LAPGC患者的切除范围不影响长期生存结果。此外，未来关于PG或TG后生活质量的随机临床试验有望帮助外科医生为LAPGC患者选择手术方法和策略。
