Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Eur J Surg Oncol. 2024 Feb;50(2):107314. doi: 10.1016/j.ejso.2023.107314. Epub 2023 Dec 7.
Recent advances in chemotherapy have resulted in successful conversion surgery (CS) for clinical stage (cStage) IVB gastric cancer (GC). This study aimed to evaluate the success rate of CS in clinical practice and determine optimal treatment strategies.
Totally, 166 patients with cStage IVB gastric and gastroesophageal junction adenocarcinoma, who underwent chemotherapy at Hyogo Medical University Hospital between January 2017 and June 2022, were included. CS was performed after confirming tumor to be M0 based on imaging and/or staging laparoscopy, except for resectable liver metastases. Preoperative chemotherapy was continued for at least 6 months provided that adverse events were manageable.
Of 125 eligible patients, 23 were treated with CS, achieving a conversion rate of 18.4% and an R0 resection rate of 91.3%. The median duration of preoperative chemotherapy was 8.5 months; the median number of cycles was eight. The highest conversion rate was observed in patients receiving first-line treatment (14.4%), followed by those receiving second and third lines (5.8% and 2.3%, respectively). The median survival time in patients who received CS was significantly longer than that in patients who continued chemotherapy alone (56.7 versus 16 months, respectively, P < 0.0001). There was no significant difference in the 3-year overall survival between the patients who achieved CS after first-line treatment (63.2%, n = 18) and those who achieved CS after second- or third-line treatment (66.7%, n = 5).
Consistent chemotherapy strategies could lead to successful CS and improved prognosis in a greater number of patients with cStage IVB GC, regardless of line of treatment.
化疗的最新进展使临床 IVB 期胃癌（GC）的转化手术（CS）获得成功。本研究旨在评估 CS 在临床实践中的成功率，并确定最佳治疗策略。
共纳入 2017 年 1 月至 2022 年 6 月在兵库医科大学医院接受化疗的 166 例临床 IVB 期胃和胃食管交界处腺癌患者。除可切除的肝转移外，在基于影像学和/或分期腹腔镜检查确认肿瘤为 M0 后，进行 CS。如果不良反应可管理，则继续进行至少 6 个月的术前化疗。
在 125 例合格患者中，23 例接受了 CS，转化率为 18.4%，R0 切除率为 91.3%。术前化疗的中位持续时间为 8.5 个月；中位周期数为 8 个。在接受一线治疗的患者中观察到最高的转化率（14.4%），其次是接受二线和三线治疗的患者（分别为 5.8%和 2.3%）。接受 CS 的患者的中位生存时间明显长于仅接受化疗的患者（分别为 56.7 个月和 16 个月，P < 0.0001）。接受一线治疗后实现 CS 的患者（63.2%，n=18）与接受二线或三线治疗后实现 CS 的患者（66.7%，n=5）的 3 年总生存率无显著差异。
无论治疗线数如何，一致的化疗策略都可以使更多的临床 IVB 期 GC 患者实现成功的 CS 并改善预后。
