Kumar Sunil, Kumar Naveen, Deo Suryanarayana, Bhoriwal Sandeep, Mandal Amitabha, Sharma Atul, Pathy Sushmita, Das Prasenjit, Thulkar Sanjay, Bhatnagar Sushma
Department of Surgical Oncology, DR. Bhim Rao Ambedkar Institute Rotary Cancer Hospital (DRBRAIRCH), All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, DR. Bhim Rao Ambedkar Institute Rotary Cancer Hospital (DRBRAIRCH), All India Institute of Medical Sciences, New Delhi, India.
Front Oncol. 2022 May 2;12:877493. doi: 10.3389/fonc.2022.877493. eCollection 2022.
Worldwide gastric cancer is the 5th most commonly diagnosed cancer and the leading cause of gastrointestinal cancer-related deaths. Alone surgery provides long-term survival improvements in 20% of the patients with local advanced gastric cancer. The results can be improved considering multimodal management including chemotherapy and radiotherapy. However, in low middle-income countries like India, multimodal management is challenging. Herein, we evaluated the experience of multimodal management of gastric cancer and the long-term outcome.
Retrospective analysis of the data of 372 patients was done from a prospectively maintained computerized database from 1994 to 2021. Records were analyzed for demographic details, treatment patterns, recurrences, and long-term outcomes (DFS and OS). Statistical analysis was done with the package SPSS version 26 (IBM Corp, Chicago, Illinois, USA).
This study included 372 patients. The mean age of the patients was 54.07. A total of 307 patients (82.5%) were operated upfront, 45 (12%) received NACT, and 20 (5.5%) underwent the palliative procedure. A total of 53.2% underwent curative resection. R0 resection rate was achieved in 95% of patients. A total of 72.58% of patients required adjuvant treatment, and the majority of the patients underwent chemoradiotherapy. The most common site of metastasis was the liver. Median follow-up was 50.16 months. The 3-year disease-free survival and overall survival were 36.28% and 67.8%, and the 5-year disease-free survival and overall survival were 30.15% and 37.7%, respectively.
Our study suggested that multimodal management is required in locally advanced gastric cancer to achieve good long-term outcomes. The treatment sequence can be tailored based on the available resources.
在全球范围内,胃癌是第五大最常被诊断出的癌症,也是胃肠道癌症相关死亡的主要原因。仅手术治疗能使20%的局部晚期胃癌患者获得长期生存改善。考虑到包括化疗和放疗在内的多模式治疗,结果可能会得到改善。然而,在像印度这样的低收入和中等收入国家,多模式治疗具有挑战性。在此,我们评估了胃癌多模式治疗的经验和长期结果。
对1994年至2021年前瞻性维护的计算机数据库中372例患者的数据进行回顾性分析。分析记录中的人口统计学细节、治疗模式、复发情况和长期结果(无病生存期和总生存期)。使用SPSS 26版软件包(美国伊利诺伊州芝加哥市IBM公司)进行统计分析。
本研究纳入372例患者。患者的平均年龄为54.07岁。共有307例患者(82.5%)接受了 upfront手术,45例(12%)接受了新辅助化疗,20例(5.5%)接受了姑息治疗。共有53.2%的患者接受了根治性切除。95%的患者实现了R0切除率。共有72.58%的患者需要辅助治疗,大多数患者接受了放化疗。最常见的转移部位是肝脏。中位随访时间为50.16个月。3年无病生存率和总生存率分别为36.28%和67.8%,5年无病生存率和总生存率分别为30.15%和37.7%。
我们的研究表明,局部晚期胃癌需要多模式治疗以获得良好的长期结果。治疗顺序可根据可用资源进行调整。