Yang Jessica, Greally Megan, Strong Vivian E, Coit Daniel G, Chou Joanne F, Capanu Marinela, Maron Steven B, Kelsen David P, Ilson David H, Janjigian Yelena Y, Ku Geoffrey Y
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
J Gastrointest Oncol. 2023 Jun 30;14(3):1193-1203. doi: 10.21037/jgo-23-4.
Perioperative chemotherapy is standard of care management for locally advanced gastric cancer (GC), but a substantial proportion of patients do not complete adjuvant therapy due to postoperative complications and prolonged recovery. Administration of all chemotherapy prior to surgery in the form of total neoadjuvant therapy (TNT) may optimize complete delivery of systemic therapy.
We performed a retrospective review of GC patients who had surgery at Memorial Sloan Kettering Cancer Center (MSKCC) from May 2014 to June 2020.
One hundred and forty-nine patients were identified; 121 patients received perioperative chemotherapy and 28 patients received TNT. TNT was chosen if patients had interim radiographic and/or clinical response to treatment. Baseline characteristics were well-balanced between the two group except for chemotherapy regimen; more TNT patients received FLOT compared to the perioperative group (79% 31%). There was no difference in the proportion of patients who completed all planned cycles, but TNT patients received a higher proportion of cycles containing all chemotherapy drugs (93% 74%, P<0.001). Twenty-nine patients (24%) in the perioperative group did not receive intended adjuvant therapy. There was no significant difference in hospital length of stay or surgical morbidity. The overall distribution of pathologic stage was similar between the two groups. Fourteen percent of TNT patients and 5.8% of perioperative patients achieved a pathologic complete response (P=0.6). There was no significant difference in recurrence free survival (RFS) or overall survival (OS) between the TNT and perioperative groups [24-month OS rate 77% 85%, HR 1.69 (95% CI: 0.80-3.56)].
Our study was limited by a small TNT sample size and biases inherent to a retrospective analysis. TNT appears to be feasible in a select population, without any increase in surgical morbidity.
围手术期化疗是局部晚期胃癌（GC）护理管理的标准，但相当一部分患者由于术后并发症和恢复时间延长而未完成辅助治疗。以全新辅助治疗（TNT）的形式在手术前给予所有化疗可能会优化全身治疗的完整给药。
我们对2014年5月至2020年6月在纪念斯隆凯特琳癌症中心（MSKCC）接受手术的GC患者进行了回顾性研究。
共确定了149例患者；121例患者接受了围手术期化疗，28例患者接受了TNT。如果患者对治疗有中期影像学和/或临床反应，则选择TNT。除化疗方案外，两组的基线特征均衡；与围手术期组相比，更多接受TNT的患者接受了FLOT方案（79%对31%）。完成所有计划疗程的患者比例没有差异，但接受TNT的患者接受包含所有化疗药物疗程的比例更高（93%对74%，P<0.001）。围手术期组中有29例患者（24%）未接受预期的辅助治疗。住院时间或手术并发症方面没有显著差异。两组之间病理分期的总体分布相似。14%接受TNT的患者和5.8%接受围手术期治疗的患者实现了病理完全缓解（P=0.6）。TNT组和围手术期组之间的无复发生存期（RFS）或总生存期（OS）没有显著差异[24个月总生存率77%对85%，风险比1.69（95%置信区间：0.80-3.56）]。
我们的研究受到TNT样本量小和回顾性分析固有偏差的限制。TNT在特定人群中似乎是可行的，且不会增加手术并发症。
