新辅助化疗和免疫治疗后老年胃癌患者微创胃切除术的安全性和有效性：倾向评分匹配分析。
Safety and efficacy of minimally invasive gastrectomy for older patients with gastric cancer after neoadjuvant chemotherapy and immunotherapy: a propensity score-matched analysis.
机构信息
School of Medicine, Nankai University, Tianjin, 300071, China.
Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing, 100853, China.
出版信息
BMC Geriatr. 2024 Jul 15;24(1):606. doi: 10.1186/s12877-024-05193-w.
BACKGROUND
The effect of neoadjuvant immunotherapy on minimally invasive gastrectomy (MIG) in older patients with gastric cancer remains controversial. This study aimed to evaluate the safety, and efficacy of MIG for older patients who underwent neoadjuvant chemotherapy and immunotherapy (NICT).
METHODS
The clinical data of 726 older patients aged over 65 years who underwent upfront MIG or MIG after NICT in the Department of General Surgery, Chinese PLA General Hospital First Medical Center between Jan 2020 and Nov 2023 were retrospectively analyzed. Propensity score-matched (PSM) analysis at a ratio of 1:2 was performed to reduce bias from confounding patient-related variables, short- and long-term outcomes were compared between the two groups.
RESULTS
The baseline characteristics were comparable between 61 patients in the NICT-MIG group and 114 patients in the MIG group after PSM (P > 0.05). The major pathological response (MPR) rate and pathological complete response (pCR) rate were 44.2% and 21.3%, respectively, in the NICT-MIG group. Patients in the NICT-MIG group had longer operation times (P = 0.005) and postoperative days (P = 0.030) than those in the MIG group. No significant differences were found in intraoperative bleeding, number of retrieved lymph nodes, first flatus day, R0 resection rate, overall postoperative complication (POC) morbidity, severe POC morbidity, 2-year overall, and recurrence-free survival between the MIG and NICT-MIG groups (P > 0.05). Multivariate logistic analysis revealed that an estimated blood loss > 200 mL (P = 0.010) and a lymphocyte-to-monocyte ratio (LMR) ≤ 3.25 (P = 0.006) were independent risk factors for POCs after MIG in older patients.
CONCLUSION
The safety, and efficacy of NICT-MIG were comparable to those of upfront MIG in older patients with GC. Patients with an estimated blood loss > 200 mL or an LMR ≤ 3.25 should be carefully evaluated for an increased risk of POCs in older patients who undergo MIG.
TRIAL REGISTRATION
Chinese Clinical Trial Registry (Registration Number: ChiCTR2400086827).
背景
新辅助免疫治疗对老年胃癌患者微创胃切除术（MIG）的影响仍存在争议。本研究旨在评估新辅助化疗和免疫治疗（NICT）后行 MIG 对老年患者的安全性和疗效。
方法
回顾性分析 2020 年 1 月至 2023 年 11 月解放军总医院第一医学中心普通外科接受 upfront MIG 或 NICT 后 MIG 的 726 例年龄超过 65 岁的老年患者的临床资料。采用 1:2 的倾向评分匹配（PSM）分析以减少混杂患者相关变量的偏倚，比较两组患者的短期和长期结局。
结果
PSM 后 NICT-MIG 组 61 例患者和 MIG 组 114 例患者的基线特征无差异（P>0.05）。NICT-MIG 组的主要病理反应（MPR）率和病理完全缓解（pCR）率分别为 44.2%和 21.3%。NICT-MIG 组患者的手术时间（P=0.005）和术后住院时间（P=0.030）长于 MIG 组。两组术中出血量、淋巴结清扫数目、首次排气时间、R0 切除率、总术后并发症（POC）发病率、严重 POC 发病率、2 年总生存率和无复发生存率无差异（P>0.05）。多变量 logistic 分析显示，术中估计出血量>200 mL（P=0.010）和淋巴细胞-单核细胞比值（LMR）≤3.25（P=0.006）是老年患者 MIG 后发生 POC 的独立危险因素。
结论
NICT-MIG 在老年 GC 患者中的安全性和疗效与 upfront MIG 相当。对于接受 MIG 的老年患者，术中估计出血量>200 mL 或 LMR≤3.25 的患者，应仔细评估 POC 风险增加。
试验注册
中国临床试验注册中心（注册号：ChiCTR2400086827）。
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