新辅助化疗后胃癌患者病理完全缓解是否能良好预测长期临床结局？一项中国多中心回顾性研究。
Is Pathologic Complete Response a Good Predictor for the Long-Term, Clinical Outcome in Patients with Gastric Cancer After Neoadjuvant Chemotherapy? A Retrospective, Multi-institution Study in China.
机构信息
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
出版信息
Ann Surg Oncol. 2023 Sep;30(9):5534-5542. doi: 10.1245/s10434-023-13728-5. Epub 2023 Jun 19.
BACKGROUND
Many studies have used pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) as the primary endpoint for the short-term efficacy in gastric cancer, but whether it is a good indicator for overall survival is poorly understood.
METHODS
This study reviewed a multi-institution database of patients who underwent radical gastrectomy and achieved pCR after NAC. Cox regression models were used to identify clinicopathologic predictors of overall survival (OS) and disease-free survival (DFS). Survival curves were calculated by using the Kaplan-Meier method and compared by means of the log-rank test.
RESULTS
OS and DFS in patients with pCR were significantly higher than in those with non-pCR (both P < 0.001). Multivariable analysis confirmed pCR was an independent prognostic factor for OS and DFS (P = 0.009 and P = 0.002 for OS and DFS, respectively). However, the survival benefit for pCR was present only for ypN0 tumors (P = 0.004 and P = 0.001 for OS and DFS, respectively), and OS (P = 0.292) and DFS (P = 0.285) among patients with ypN+ gastric cancer could not be stratified by pCR.
CONCLUSIONS
In our study, pCR is an independent prognostic factor for OS and DFS, but the survival benefit for pCR is present only for ypN0 tumors but not ypN+ tumors.
背景
许多研究将新辅助化疗（NAC）后病理完全缓解（pCR）作为胃癌短期疗效的主要终点，但它是否是总生存期的良好指标尚不清楚。
方法
本研究回顾性分析了多机构数据库中接受根治性胃切除术且 NAC 后达到 pCR 的患者。使用 Cox 回归模型确定总生存期（OS）和无病生存期（DFS）的临床病理预测因素。使用 Kaplan-Meier 方法计算生存曲线，并通过对数秩检验进行比较。
结果
pCR 患者的 OS 和 DFS 明显高于非 pCR 患者（均 P <0.001）。多变量分析证实 pCR 是 OS 和 DFS 的独立预后因素（OS 和 DFS 的 P 值分别为 0.009 和 0.002）。然而，pCR 的生存获益仅存在于 ypN0 肿瘤中（OS 和 DFS 的 P 值分别为 0.004 和 0.001），ypN+ 胃癌患者的 OS（P = 0.292）和 DFS（P = 0.285）不能通过 pCR 分层。
结论
在本研究中，pCR 是 OS 和 DFS 的独立预后因素，但 pCR 的生存获益仅存在于 ypN0 肿瘤中，而不存在于 ypN+ 肿瘤中。
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