Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Surg Oncol. 2024 Mar;129(3):481-488. doi: 10.1002/jso.27521. Epub 2023 Nov 20.
BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NAC) and chemoradiation (NCRT) have demonstrated improved survival for gastric cancer. However, the optimal neoadjuvant treatment remains unclear. We sought to evaluate perioperative and histopathologic outcomes among neoadjuvant treatments for locoregional gastric cancer.
The National Cancer Database queried patients who received NAC or NCRT followed by resection for T2-T4 and/or node-positive gastric cancer (2006-2018). Logistic and Poisson regression assessed perioperative (30-day readmission, 30- and 90-day mortality, length of stay [LOS]) and histopathologic outcomes (pathologic complete response [PCR], margin status, and negative pathologic lymph nodes [ypN0]). Kaplan-Meier methods and Cox regression assessed overall survival (OS).
Of 9831 patients, 4221 (42.9%) received NAC and 5610 (57.1%) NCRT. There were no differences in perioperative outcomes, apart from patients treated with NCRT exhibiting increased LOS (incidence rate ratio 1.09, 95% confidence interval [CI] 1.03-1.16). Patients who received NCRT were more likely to achieve PCR, margin-negative resection, and ypN0 (all p < 0.05). Median OS was 36.8 months for NAC and 33.6 months for NCRT (p < 0.001). NCRT independently predicted worse OS (vs. NAC, hazard ratio 1.10, 95% CI 1.03-1.18).
NCRT was associated with better histologic tumor response although NAC was associated with improved OS. Better understanding prognostication through histologic assessment following neoadjuvant therapy is needed.
新辅助化疗（NAC）和放化疗（NCRT）已证明可提高胃癌的生存率。然而，最佳的新辅助治疗方法仍不清楚。我们旨在评估局部进展期胃癌新辅助治疗的围手术期和组织病理学结果。
国家癌症数据库检索了接受 NAC 或 NCRT 后行 T2-T4 和/或淋巴结阳性胃癌切除术的患者（2006-2018 年）。使用逻辑回归和泊松回归评估围手术期（30 天再入院、30 天和 90 天死亡率、住院时间 [LOS]）和组织病理学结果（病理完全缓解 [PCR]、切缘状态和阴性病理淋巴结 [ypN0]）。Kaplan-Meier 方法和 Cox 回归分析总生存（OS）。
在 9831 例患者中，4221 例（42.9%）接受 NAC，5610 例（57.1%）接受 NCRT。除了接受 NCRT 的患者 LOS 增加（发生率比 1.09，95%置信区间 [CI] 1.03-1.16）外，两组患者在围手术期结果方面没有差异。接受 NCRT 的患者更可能实现 PCR、切缘阴性切除和 ypN0（均 p<0.05）。NAC 的中位 OS 为 36.8 个月，NCRT 为 33.6 个月（p<0.001）。NCRT 独立预测 OS 更差（与 NAC 相比，风险比 1.10，95%CI 1.03-1.18）。
NCRT 与更好的组织学肿瘤反应相关，而 NAC 与改善的 OS 相关。需要更好地通过新辅助治疗后的组织学评估来理解预后。
