拉丁美洲胃癌患者根治性D2胃切除术后的辅助化疗。
Adjuvant chemotherapy after curative D2 gastrectomy in Latin American patients with gastric cancer.
作者信息
Serrano Mariana, Araujo Jhajaira M, Pacheco Cristian, Macetas Jackeline, Blum Mariella A, Carrato Alfredo, Ruiz Eloy, Berrospi Francisco, Luque Carlos, Chavez Ivan, Payet Eduardo, Taxa Luis, Montenegro Paola
机构信息
Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru.
Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima 15067, Peru.
出版信息
Ecancermedicalscience. 2022 May 12;16:1387. doi: 10.3332/ecancer.2022.1387. eCollection 2022.
BACKGROUND
Gastric cancer (GC) is the fourth most common cause of cancer deaths around the world and the first cause of cancer deaths in Peru; however, there are no prospective trials for adjuvant chemotherapy in GC after curative gastrectomy in this country. The objective of this study was to evaluate the effectiveness of adjuvant chemotherapy in stage II-III gastric cancer patients who underwent D2 gastrectomy.
METHODS
We included patients with stage II-III gastric cancer who underwent radical gastrectomy and D2 dissection between 2014 and 2016 at our institution. Patients received 3-week cycles of capecitabine (1,000 mg/m twice daily on days 1-14) plus oxaliplatin (130 mg/m on day 1) for 6 months. Survival curves were estimated with the Kaplan-Meier method, and the Cox proportional hazards model was used to identify prognostic factors for survival.
RESULTS
In total, 173 patients were included: 100 (57.8%) patients received adjuvant chemotherapy and surgery (AChS) and 73 (42.2%) surgery alone (SA). Three-year disease-free survival (DFS) was higher in the AChS groups (69%) than in the SA group (52.6%) ( = 0.034). Regarding overall survival (OS), 31 patients (31%) died in the AChS group compared with 34 (46.6%) in the SA group ( = 0.027). In the multivariate analysis, adjuvant chemotherapy was an independent prognostic factor for DFS (HR = 0.60; 95% CI = 0.37-0.97; = 0.036) and OS (HR = 0.58; 95% CI = 0.36-0.95; = 0.029). ACh showed consistent benefit in DFS and OS for patients with albumin >3.5 g/dL, lymphovascular and perineural invasion, pT4, pN2-3, pathologic stage (PS) IIIA and IIIB and lymph node ratio (LNR) > 13.1.
CONCLUSION
These data suggest that adjuvant capecitabine and oxaliplatin reduce the recurrence and mortality in patients with stage II-III gastric cancer who underwent D2 gastrectomy. PS IIIA and IIIB and LNR > 13.1 benefited more from receiving adjuvant chemotherapy and poorly cohesive gastric carcinoma did not significantly reduce the rates of survival.
背景
胃癌（GC）是全球第四大致癌死亡原因，在秘鲁是癌症死亡的首要原因；然而，该国尚无针对根治性胃切除术后胃癌辅助化疗的前瞻性试验。本研究的目的是评估接受D2胃切除术的II - III期胃癌患者辅助化疗的有效性。
方法
我们纳入了2014年至2016年在我们机构接受根治性胃切除术和D2淋巴结清扫的II - III期胃癌患者。患者接受为期3周的卡培他滨（第1 - 14天每日两次，每次1000 mg/m²）加奥沙利铂（第1天130 mg/m²）的周期治疗，共6个月。采用Kaplan - Meier方法估计生存曲线，并使用Cox比例风险模型确定生存的预后因素。
结果
总共纳入173例患者：100例（57.8%）患者接受辅助化疗加手术（AChS），73例（42.2%）仅接受手术（SA）。AChS组的三年无病生存率（DFS）（69%）高于SA组（52.6%）（P = 0.034）。关于总生存期（OS），AChS组有31例（31%）死亡，而SA组有34例（46.6%）死亡（P = 0.027）。在多变量分析中，辅助化疗是DFS（HR = 0.60；95%CI = 0.37 - 0.97；P = 0.036）和OS（HR = 0.58；95%CI = 0.36 - 0.95；P = 0.029）的独立预后因素。对于白蛋白>3.5 g/dL、存在淋巴管和神经周围侵犯、pT4、pN2 - 3、病理分期（PS）IIIA和IIIB以及淋巴结比值（LNR）>13.1的患者，ACh在DFS和OS方面显示出一致的益处。
结论
这些数据表明，辅助性卡培他滨和奥沙利铂可降低接受D2胃切除术的II - III期胃癌患者的复发率和死亡率。PS IIIA和IIIB以及LNR>13.1的患者从接受辅助化疗中获益更多，而低黏附性胃癌并未显著降低生存率。
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