Ajay Pranay S, Mavani Parit T, Sok Caitlin P, Goyal Subir, Switchenko Jeffery M, Gillespie Theresa W, Kooby David A, Kennedy Timothy J, Shah Mihir M
Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
J Surg Oncol. 2024 Oct;130(5):1078-1091. doi: 10.1002/jso.27835. Epub 2024 Aug 27.
To determine the optimal multimodal treatment strategy between perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC) in resected gastric cancer (GC) patients based on nodal status.
In this retrospective analysis, the National Cancer Database was used to identify resected non-metastatic GC (2006-2016). Patients were stratified by clinical nodal status-negative (cLN-) and positive (cLN+). In patients with cLN- disease who underwent upfront resection and were upstaged to pathological LN+, overall survival (OS) was compared between POC and POCR. In patients with cLN- and cLN+ disease, OS was compared between PEC, POCR, and POC. Kaplan-Meier survival estimate, log-rank test, and multivariable Cox proportional hazards analysis were performed.
We identified 7827 patients (cLN- 4828; cLN+ 2999). On multivariable analysis in patients with cLN- disease who underwent upfront resection (n = 4314) and were upstaged to pLN+ disease (70%), POCR (n = 2300, aHR 0.78, 95% CI 0.70-0.87, p < 0.001) was associated with improved OS compared to POC (n = 907). No significant difference was noted between POCR (n = 766, aHR 1.11, 95% CI 0.88-1.40, p = 0.39) and POC (n = 341) in patients with pLN- disease. On multivariable analysis in all patients with cLN- disease, POCR (n = 3066) was significantly associated with improved OS (aHR 0.84, 95% CI 0.75-0.92, p < 0.01) compared to POC (n = 1248). No significant difference was noted between POCR (aHR 1.0, 95% CI 0.70-1.01, p = 0.958) and PEC (n = 514). These results remained consistent in patients with cLN+ disease (POCR = 1602, POC = 720, PEC = 677).
Postoperative chemoradiation is associated with improved survival in GC patients upstaged from clinically node-negative disease to pathologically node-positive disease. Negative clinical nodal disease status is not a reliable indicator of pathological nodal disease.
基于淋巴结状态确定接受手术切除的胃癌（GC）患者围手术期化疗（PEC）、术后放化疗（POCR）和术后化疗（POC）之间的最佳多模式治疗策略。
在这项回顾性分析中，使用国家癌症数据库识别接受手术切除的非转移性GC患者（2006 - 2016年）。患者按临床淋巴结状态阴性（cLN-）和阳性（cLN+）分层。在接受 upfront 切除且分期上调至病理淋巴结阳性的cLN-疾病患者中，比较POC和POCR的总生存期（OS）。在cLN-和cLN+疾病患者中，比较PEC、POCR和POC的OS。进行了Kaplan-Meier生存估计、对数秩检验和多变量Cox比例风险分析。
我们识别出7827例患者（cLN- 4828例；cLN+ 2999例）。在接受 upfront 切除且分期上调至pLN+疾病（70%）的cLN-疾病患者的多变量分析中（n = 4314），与POC（n = 907）相比，POCR（n = 2300，aHR 0.78，95%CI 0.70 - 0.87，p < 0.001）与OS改善相关。在pLN-疾病患者中，POCR（n = 766，aHR 1.11，95%CI 0.88 - 1.40，p = ）和POC（n = 341）之间未观察到显著差异。在所有cLN-疾病患者的多变量分析中，与POC（n = 1248）相比，POCR（n = 30,66）与OS改善显著相关（aHR 0.84，95%CI 0.75 - 0.92，p < 0.01）。POCR（aHR 1.0，95%CI 0.70 - 1.01，p = 0.958）和PEC（n = 514）之间未观察到显著差异。这些结果在cLN+疾病患者中（POCR = 1602，POC = 720，PEC = 677）保持一致。
术后放化疗与从临床淋巴结阴性疾病分期上调至病理淋巴结阳性疾病的GC患者的生存改善相关。临床淋巴结阴性疾病状态不是病理淋巴结疾病的可靠指标。
