Mei Yu, Feng Xijia, Feng Tienan, Yan Min, Zhu Zhenggang, Li Tian, Zhu Zhenglun
Department of General Surgery, Gastrointestinal Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Pharmacol. 2022 Feb 17;13:845261. doi: 10.3389/fphar.2022.845261. eCollection 2022.
There is no global consensus on adjuvant chemotherapy (ACT) for pT2N0M0 gastric cancer. We conducted a retrospective study to reveal the role of ACT in such patients. Patients with pT2N0M0 gastric cancer who underwent radical resection with D2 lymphadenectomy for primary gastric cancer between January 2012 and May 2016 were included. Kaplan-Meier and Cox regression were used to evaluate overall survival (OS), disease-specific survival (DSS) and predictors of prognosis. Stratified analysis based on high-risk factors was conducted. Of enrolled 307 patients, 111 patients underwent surgery alone and 196 patients received ACT. Surgery alone (HR = 2.913, 95% CI: 1.494-5.682, = 0.002) and total gastrectomy (HR = 2.445, 95% CI: 1.279-4.675, = 0.007) were independently associated with decreased OS. With the median follow-up of 73.1 months, the 5-year OS rate was 87.9% and 5-year DSS rate was 91.8%. Patients receiving ACT showed a better 5-year OS rate (92.9 . 79.3%, < 0.001) and DSS rate (96.8 vs. 83.0%, < 0.001) than patients underwent surgery alone. Patients receiving monotherapy ( = 130) had a relatively poor prognosis compared to patients receiving dual-drug ( = 66) without a significant difference (92.3 . 93.9%, = 0.637). In patients without high-risk factors based on the Chinese Society of Clinical Oncology (CSCO) Guidelines, ACT also provided survival benefit (96.0 vs 82.9%, = 0.038). ACT was accompanied with higher 5-year OS and DSS rates of patients with pT2N0M0 gastric cancer. Patients with pT2N0M0 gastric cancer, regardless of high-risk factors based on the CSCO guidelines, might be considered candidates for ACT. In regard to the therapy regimen, monotherapy might be the optimal choice, considering the adverse events.
对于pT2N0M0期胃癌的辅助化疗（ACT），目前尚无全球共识。我们进行了一项回顾性研究，以揭示ACT在此类患者中的作用。纳入了2012年1月至2016年5月期间因原发性胃癌接受D2淋巴结清扫术根治性切除的pT2N0M0期胃癌患者。采用Kaplan-Meier法和Cox回归分析评估总生存期（OS）、疾病特异性生存期（DSS）及预后预测因素，并基于高危因素进行分层分析。在纳入的307例患者中，111例仅接受手术治疗，196例接受ACT。仅手术治疗（HR = 2.913，95%CI：1.494 - 5.682，P = 0.002）和全胃切除术（HR = 2.445，95%CI：1.279 - 4.675，P = 0.007）与OS降低独立相关。中位随访73.1个月，5年OS率为87.9%，5年DSS率为91.8%。接受ACT的患者5年OS率（92.9%对79.3%，P < 0.001）和DSS率（96.8%对83.0%，P < 0.001）均优于仅接受手术治疗的患者。与接受双联药物治疗的患者（n = 66）相比，接受单药治疗的患者（n = 130）预后相对较差，但差异无统计学意义（92.3%对93.9%，P = 0.637）。在中国临床肿瘤学会（CSCO）指南定义的无高危因素的患者中，ACT也能带来生存获益（96.0%对82.9%，P = 0.038）。ACT可提高pT2N0M0期胃癌患者的5年OS率和DSS率。对于pT2N0M0期胃癌患者，无论是否符合CSCO指南定义的高危因素，均可考虑ACT。在治疗方案方面，考虑到不良事件，单药治疗可能是最佳选择。
