Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland.
Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
Ann Surg Oncol. 2024 Aug;31(8):5273-5282. doi: 10.1245/s10434-024-15418-2. Epub 2024 May 18.
According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences.
The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients.
A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups.
Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p < 0.001) and had a better health status (World Health Organization performance status = 0 in 60.3% of CS patients vs. 34.5% of S patients; p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW.
Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
根据当前的国际指南，cT2N0M0 期胃腺癌需要术前化疗，然后再进行手术。然而，根据患者的临床状况和当地治疗偏好，手术通常是首选。
本研究旨在评估新辅助化疗对 cT2N0M0 患者总生存（OS）和无病生存（DFS）的影响。
对 2007 年 1 月至 2017 年 12 月期间接受手术的 32 家中心的胃腺癌患者进行回顾性分析。将 cT2N0M0 期患者分为直接手术（S）和新辅助化疗后手术（CS）组。采用逆概率治疗加权（IPTW）来补偿两组间的基线差异。
在诊断为 cT2N0M0 期的 202 例患者中，CS 组有 68 例（33.7%），S 组有 134 例（66.3%）。CS 组患者年龄较小（平均年龄 62.7 ± 12.8 岁 vs. S 组患者 69.8 ± 12.1 岁；p < 0.001），健康状况较好（CS 组患者的世界卫生组织表现状态为 0 的比例为 60.3%，而 S 组为 34.5%；p = 0.006）。经 IPTW 校正后，随访期间 CS 组和 S 组的复发率分别为 27.2%和 19.6%（p = 0.32）。CS 组和 S 组的 5 年 OS 无显著差异（78.9% vs. 68.3%；p = 0.42），5 年 DFS 也无显著差异（70.4% vs. 68.5%；p = 0.96）。多变量分析后，经 IPTW 校正，新辅助化疗与 OS 和 DFS 均无相关性。
与单纯手术相比，cT2N0M0 期胃腺癌患者接受围手术期化疗后再手术并没有生存或复发获益。
