临床T2N0期胃癌患者的分期准确性：对治疗顺序的影响。
Staging accuracy in patients with clinical T2N0 gastric cancer: Implications for treatment sequencing.
作者信息
Baril Jackson A, Ruedinger Brian M, Nguyen Trang K, Bilimoria Karl Y, Ceppa Eugene P, Maatman Thomas K, Roch Alexandra M, Schmidt C Max, Turk Anita, Yang Anthony D, House Michael G, Ellis Ryan J
机构信息
Division of Surgical Oncology, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
出版信息
Surgery. 2025 Mar;179:108796. doi: 10.1016/j.surg.2024.07.055. Epub 2024 Oct 2.
BACKGROUND
Patients with clinical T2N0 (cT2N0) gastric adenocarcinoma are recommended to undergo either perioperative chemotherapy or upfront resection. If T2N0 disease is pathologically confirmed, patients may be observed without chemotherapy. These guidelines create the possibility of both systemic therapy overuse and underuse depending on clinical staging accuracy. Our objectives were to define factors associated with upstaging after upfront resection and describe the association between postoperative chemotherapy and survival.
METHODS
Patients with cT2N0 gastric adenocarcinoma were identified using the National Cancer Database. Factors associated with upstaging were assessed by logistic regression. Survival was assessed using Kaplan-Meier and Cox proportional hazard analyses.
RESULTS
Of 4,076 patients undergoing upfront resection for cT2N0 gastric cancer, 1,933 (47.4%) were pathologically upstaged. Patients were more likely to be upstaged if they had >3.0-cm (adjusted odds ratio [aOR] 2.31, 95% confidence interval [CI] 1.97-2.70; P < .001) or poorly differentiated tumors (aOR 2.22, 95% CI 1.89-2.60; P < .001). Patients were less likely to be upstaged if they had distal tumors (aOR 0.77, 95% CI 0.64-0.93; P = .006). Of those pathologically upstaged (n = 1,933), 1,111 (57.4%) received adjuvant chemotherapy that was associated with improved survival (HR 0.55, 95% CI 0.47-0.63; P < .001). Among those not upstaged (n = 2,143), 247 (11.5%) received adjuvant chemotherapy that was not associated with improved survival (HR 0.92, 95% CI 0.70-1.21; P = .54).
CONCLUSIONS
Pathologic upstaging after upfront resection in patients with cT2N0 gastric cancer is associated with patient and tumor characteristics. Adjuvant chemotherapy is associated with improved survival only in the patients upstaged at surgery. An upfront surgical approach may be preferred in select patients, especially if avoiding chemotherapy is desired.
背景
临床T2N0（cT2N0）期胃腺癌患者推荐接受围手术期化疗或直接手术切除。如果T2N0疾病经病理证实，患者可在不进行化疗的情况下进行观察。这些指南根据临床分期的准确性，造成了全身治疗过度使用和使用不足的可能性。我们的目标是确定直接手术切除后分期上调相关的因素，并描述术后化疗与生存之间的关联。
方法
利用国家癌症数据库识别cT2N0期胃腺癌患者。通过逻辑回归评估与分期上调相关的因素。使用Kaplan-Meier法和Cox比例风险分析评估生存情况。
结果
在4076例接受cT2N0期胃癌直接手术切除的患者中，1933例（47.4%）病理分期上调。肿瘤直径>3.0 cm（校正比值比[aOR] 2.31，95%置信区间[CI] 1.97 - 2.70；P <.001）或分化差的肿瘤患者（aOR 2.22，95% CI 1.89 - 2.60；P <.001）更有可能分期上调。远端肿瘤患者分期上调的可能性较小（aOR 0.77，95% CI 0.64 - 0.93；P =.006）。在病理分期上调的患者（n = 1933）中，1111例（57.4%）接受了辅助化疗，这与生存改善相关（风险比[HR] 0.55，95% CI 0.47 - 0.63；P <.001）。在未分期上调的患者（n = 2143）中，247例（11.5%）接受了辅助化疗，这与生存改善无关（HR 0.92，95% CI 0.70 - 1.21；P =.54）。
结论
cT2N0期胃癌患者直接手术切除后的病理分期上调与患者及肿瘤特征相关。辅助化疗仅与手术分期上调的患者生存改善相关。对于部分患者，尤其是希望避免化疗的患者，直接手术 approach 可能更可取。 （注：这里原文“An upfront surgical approach may be preferred in select patients, especially if avoiding chemotherapy is desired.”中“approach”翻译为“approach”可能不太准确，结合语境推测可能是“术式”之类的意思，但按照要求未做修改）
Zotero 插件