Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China.
Clin Transl Oncol. 2023 Aug;25(8):2462-2471. doi: 10.1007/s12094-023-03130-8. Epub 2023 Apr 24.
Preoperative chemotherapy has been increasingly used in locally advanced gastric cancer (LAGC). However, the prognostic factors are still insufficient. This study aimed to investigate the prognostic significance of pathological response of the primary tumor to neoadjuvant chemotherapy (NACT) and the lymph node status after NACT.
Data from 160 patients with LAGC treated with NACT followed by gastrectomy and met the inclusion criteria between March 2016 and December 2019 were retrospectively reviewed. Pathological evaluation after NACT was based on the grade of pathological response of the primary tumor and the status of lymph node. Survival curves for overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival difference. Univariate and multivariate analyses for prognostic factors were based on the Cox regression.
Among 160 selected cases, 90 had pathological response (PR), while 70 had no pathological response (nPR) to NACT. Smaller tumor size was presented in PR group, which also had lower level of signet ring cell features, compared to nPR group (all p < 0.05). Based on the status of lymph nodes, nodal status (-) group showed smaller tumor size, lower depth of tumor invasion, better differentiated degree, lower level of signet ring cell features, lower rate of lymphatic and venous invasion and less advanced ypTNM stage (all p < 0.05). Survival was equivalent between PR and nPR group (all p > 0.05), while patients with no lymph node metastasis had better DFS than that with lymph node metastasis (HR 0.301, 95% CI 0.194-0.468, p = 0.002). Multivariable Cox regression analysis identified that lymph node status after NACT was an independent prognostic factor associated with survival (OS: hazard ratio 1.756, 95% CI 1.114-3.278, p = 0.029; DFS: hazard ratio 1.901, 95% CI 1.331-3.093, p = 0.012).
Lymph node status is a potential independent prognostic factor for LAGC patients treated with NACT and may be more efficient than pathological response in primary tumor.
术前化疗已越来越多地用于局部晚期胃癌（LAGC）。然而，预后因素仍然不足。本研究旨在探讨新辅助化疗（NACT）后原发肿瘤病理反应和 NACT 后淋巴结状态的预后意义。
回顾性分析了 2016 年 3 月至 2019 年 12 月期间接受 NACT 后胃切除术且符合纳入标准的 160 例 LAGC 患者的数据。NACT 后病理评估基于原发肿瘤病理反应程度和淋巴结状态。使用 Kaplan-Meier 法估计总生存期（OS）和无病生存期（DFS）的生存曲线，并使用对数秩检验比较生存差异。单因素和多因素预后因素分析基于 Cox 回归。
在 160 例入选病例中，90 例对 NACT 有病理反应（PR），70 例无病理反应（nPR）。PR 组肿瘤较小，与 nPR 组相比，印戒细胞特征水平较低（均 p<0.05）。根据淋巴结状态，淋巴结（-）组肿瘤较小，肿瘤浸润深度较浅，分化程度较好，印戒细胞特征水平较低，淋巴管和静脉侵犯率较低，ypTNM 分期较晚（均 p<0.05）。PR 组和 nPR 组的生存相当（均 p>0.05），而无淋巴结转移的患者的 DFS 优于有淋巴结转移的患者（HR 0.301，95%CI 0.194-0.468，p=0.002）。多因素 Cox 回归分析确定 NACT 后淋巴结状态是与生存相关的独立预后因素（OS：风险比 1.756，95%CI 1.114-3.278，p=0.029；DFS：风险比 1.901，95%CI 1.331-3.093，p=0.012）。
淋巴结状态是接受 NACT 治疗的 LAGC 患者的潜在独立预后因素，其在原发肿瘤中的效率可能高于病理反应。
