Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
World J Surg. 2023 Jun;47(6):1512-1518. doi: 10.1007/s00268-023-06934-5. Epub 2023 Feb 23.
Gastrectomy with D2 dissection has been established as the standard procedure for locally advanced gastric cancer in the era of surgery alone. However, no consideration has been given to the efficacy of dissection in the era of effective adjuvant chemotherapy.
This study included 1298 advanced gastric cancer patients, consisting of 725 cases treated between January 2000 and December 2006 (Former group), and 573 cases treated between January 2007 and July 2015 (Latter group). Clinicopathological data were collected, survival and the therapeutic value index were determined.
The background characteristics were well balanced, except for age, tumor location, and intraoperative blood loss. The Latter group showed the following characteristics: an older population (p < 0.001), a frequent upper location (p = 0.008), and less blood loss (p < 0.001). Adjuvant chemotherapy was administered to 75.2% of the Latter group and was 9.4% in the Former group. The 5-year overall survival rate of the Latter group was 75.7% (95% confidence interval: 71.7-79.1), significantly better than that of the Former group (70.0%, 95% confidence interval: 66.5-73.2) (p = 0.025). Improvement in the index from the Former group was observed in the Latter group at almost all stations. The ratio of the index between these two groups was 1.09 at the D1 station and 1.19 at the D2 station.
The therapeutic value index was improved in all nodal stations by S-1 adjuvant chemotherapy, regardless of whether the D1 or D2 nodes were involved. D2 gastrectomy would be still important for locally advanced gastric cancer in the era of effective adjuvant chemotherapy.
在单独手术的时代，胃切除术加 D2 解剖已被确立为局部进展期胃癌的标准治疗方法。然而，在有效的辅助化疗时代，尚未考虑解剖的疗效。
本研究纳入了 1298 例进展期胃癌患者，其中 725 例患者于 2000 年 1 月至 2006 年 12 月（前组）接受治疗，573 例患者于 2007 年 1 月至 2015 年 7 月（后组）接受治疗。收集临床病理资料，确定生存和治疗价值指数。
除了年龄、肿瘤部位和术中出血量外，两组的背景特征均均衡。后组患者年龄较大（p<0.001），肿瘤位置较高（p=0.008），术中出血量较少（p<0.001）。后组中有 75.2%的患者接受了辅助化疗，而前组仅有 9.4%。后组患者的 5 年总生存率为 75.7%（95%置信区间：71.7-79.1），明显优于前组（70.0%，95%置信区间：66.5-73.2）（p=0.025）。在后组中，几乎所有站点的治疗价值指数都从前组得到改善。两组间该指数的比值在 D1 站为 1.09，在 D2 站为 1.19。
S-1 辅助化疗在所有淋巴结站都提高了治疗价值指数，无论是否涉及 D1 或 D2 淋巴结。在有效的辅助化疗时代，D2 胃切除术对于局部进展期胃癌仍然重要。
