新辅助化疗联合多西他赛、顺铂和替吉奥治疗 III 期胃癌的长期疗效。

Long-term Outcomes of Neoadjuvant Chemotherapy With Docetaxel, Cisplatin and S-1 for Stage III Gastric Cancer.

机构信息

Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.

Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan;

出版信息

Anticancer Res. 2023 Jun;43(6):2841-2850. doi: 10.21873/anticanres.16453.

DOI:10.21873/anticanres.16453

PMID:37247913

Abstract

BACKGROUND/AIM: In the previous phase I/II study, we established neoadjuvant chemotherapy (NAC) using bi-weekly docetaxel, cisplatin, and S-1 (DCS) for clinical stage III gastric cancer. This study aimed to clarify long-term outcomes of this treatment.

PATIENTS AND METHODS

Relapse-free survival (RFS) and overall survival (OS) were calculated by the Kaplan-Meier method and prognostic factors for RFS and OS were identified by univariate analysis.

RESULTS

A total of 47 patients with clinical stage III gastric cancer were enrolled in this study. The 5-year RFS and OS rates were 69.8% and 74.3%, respectively, in all registered patients. Moreover, the 5-year OS and RFS rates in patients receiving R0 gastrectomy were 68.0% and 79.4%, respectively. Neutrophil-lymphocyte ratio (NLR) before NAC ≥2.41, prognostic nutritional index (PNI) before NAC ≤50.4, Glasgow prognostic score before NAC classification 2, NLR after NAC ≥1.43, PNI after NAC <48.0, and Grade 1a/1b pathological response significantly worsened RFS. NLR after NAC ≥1.43, PNI before NAC ≤50.4, NLR after NAC ≥1.43, and body weight loss >5 kg after NAC significantly worsened OS.

CONCLUSION

Although bi-weekly DCS therapy as neoadjuvant setting showed acceptable long-term outcomes, poor immune-nutritional status before and after NAC caused worse long-term survival in stage III gastric cancer patients. It is warranted to conduct a well-designed prospective randomized control study to compare long-term outcomes using the bi-weekly DCS regimen between patients with and without immune-nutritional support during peri-NAC.

摘要

背景/目的：在之前的 I/II 期研究中，我们使用每周两次的多西他赛、顺铂和 S-1（DCS）对临床 III 期胃癌进行新辅助化疗（NAC）。本研究旨在阐明这种治疗的长期结果。

患者和方法

通过 Kaplan-Meier 方法计算无复发生存期（RFS）和总生存期（OS），并通过单因素分析确定 RFS 和 OS 的预后因素。

结果

本研究共纳入 47 例临床 III 期胃癌患者。所有登记患者的 5 年 RFS 和 OS 率分别为 69.8%和 74.3%。此外，接受 RO 胃切除术的患者的 5 年 OS 和 RFS 率分别为 68.0%和 79.4%。NAC 前中性粒细胞与淋巴细胞比值（NLR）≥2.41、NAC 前预后营养指数（PNI）≤50.4、NAC 前格拉斯哥预后评分分类 2、NAC 后 NLR≥1.43、PNI 后<48.0 和 1a/1b 级病理反应显著降低 RFS。NAC 后 NLR≥1.43、NAC 前 PNI≤50.4、NAC 后 NLR≥1.43 和 NAC 后体重减轻>5kg 显著降低 OS。