Gu Tingfei, Wang Yinkui, Wu Zhouqiao, He Ning, Li Yingai, Shan Fei, Li Ziyu, Ji Jiafu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Translational Research, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Chin Med J (Engl). 2025 Aug 20;138(16):1984-1990. doi: 10.1097/CM9.0000000000003232. Epub 2024 Aug 2.
Neoadjuvant therapy enhances the possibility of achieving radical resection and improves the prognosis for locally advanced gastric cancer (GC). However, there is a lack of evidence regarding the optimal extent of resection for locally advanced proximal GC after neoadjuvant therapy.
In this study, 330 patients underwent resection in Peking University Cancer Hospital, with curative intent after neoadjuvant therapy for histologically confirmed proximal GC from January 2009 to December 2022.
In this study, 45 patients underwent proximal gastrectomy (PG), while 285 underwent total gastrectomy (TG). After propensity-score matching, 110 patients (71 TG and 39 PG) were included in the analysis. No significant differences between PG and TG regarding short-term outcomes and long-term prognosis were found. Specifically, PG demonstrated comparable overall survival to TG ( P = 0.47). Subgroup analysis revealed that although not statistically significant, PG showed a potential advantage over TG in overall survival for patients with tumor-long diameters less than 4 cm ( P = 0.31). However, for those with a long diameter larger than 4 cm, TG had a better survival probability ( P = 0.81). No substantial differences were observed in baseline characteristics, surgical safety, postoperative recovery, and postoperative complications.
For locally advanced proximal GC with objective response to neoadjuvant therapy (long diameter <4 cm), PG is an alternative surgical procedure.
新辅助治疗提高了实现根治性切除的可能性，并改善了局部晚期胃癌（GC）的预后。然而，关于新辅助治疗后局部晚期近端GC的最佳切除范围，目前缺乏证据。
本研究纳入了2009年1月至2022年12月期间在北京大学肿瘤医院接受手术切除的330例经组织学确诊的近端GC患者，这些患者在新辅助治疗后具有治愈意图。
本研究中，有45例患者接受了近端胃切除术（PG），285例接受了全胃切除术（TG）。在倾向评分匹配后，110例患者（71例TG和39例PG）纳入分析。PG组和TG组在短期结局和长期预后方面未发现显著差异。具体而言，PG组与TG组的总生存率相当（P = 0.47）。亚组分析显示，尽管差异无统计学意义，但对于肿瘤长径小于4 cm的患者，PG组在总生存方面显示出优于TG组的潜在优势（P = 0.31）。然而，对于长径大于4 cm的患者，TG组的生存概率更好（P = 0.81）。在基线特征、手术安全性、术后恢复和术后并发症方面未观察到实质性差异。
对于对新辅助治疗有客观反应（长径<4 cm）的局部晚期近端GC，PG是一种可选择的手术方式。
