Vitello Dominic J, Zaza Norah N, Bates Kelly R, Janczewski Lauren M, Rodriguez Gladys, Bentrem David J
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA.
J Surg Oncol. 2024 Dec;130(8):1563-1572. doi: 10.1002/jso.27863. Epub 2024 Oct 10.
The treatment of gastric adenocarcinoma (GA) continues to evolve. While neoadjuvant chemotherapy (NAC) has demonstrated emerging benefit, the optimal treatment regimen, and sequence remain to be firmly established.
Patients with nonmetastatic GA who underwent resection were identified within the 2020 National Cancer Database. Patients were compared between the mutually exclusive treatment groups of NAC, neoadjuvant chemoradiotherapy (NCRT), adjuvant chemotherapy, adjuvant chemoradiotherapy (CRT), and surgery only. The primary endpoint was receipt of NAC or NCRT. Patients were 1-to-1 propensity score matched for receiving any neoadjuvant therapy. Multivariable logistic regression was used to identify predictors of receipt of any neoadjuvant therapy and receipt of any adjuvant therapy.
Twenty-five thousand and seventy-three patients were included in the analysis. Patients were treated with NAC (25.0%), NCRT (31.4%), adjuvant chemotherapy (6.5%), adjuvant CRT (12.6%), and surgery only (24.5%). Compared to 2006-2011, patients diagnosed between 2012 and 2017 experienced the greatest increases in NAC (18.6% vs. 29.0%; p < 0.001) and NCRT (25.0% vs. 35.5%; p < 0.001). Median OS was 44.9 months. OS was longest for patients who received any neoadjuvant therapy compared to those receiving adjuvant or surgery only (51.0 vs. 42.4 vs. 38.0 months, respectively; p < 0.001). Patients who were Black, in the lowest income quartile or treated at lower volume facilities were less likely to receive NAT (all p < 0.001).
There has been significant acceleration in the use of neoadjuvant therapy for GA. Currently, NCRT followed by surgery are the most common treatment sequences in the United States. Additional trials are needed to further define the optimal treatment sequence.
胃腺癌（GA）的治疗方法不断发展。虽然新辅助化疗（NAC）已显示出越来越多的益处，但最佳治疗方案和顺序仍有待确定。
在2020年国家癌症数据库中识别接受手术切除的非转移性GA患者。将患者在NAC、新辅助放化疗（NCRT）、辅助化疗、辅助放化疗（CRT）和单纯手术这几个相互排斥的治疗组之间进行比较。主要终点是接受NAC或NCRT。对接受任何新辅助治疗的患者进行1:1倾向评分匹配。使用多变量逻辑回归来确定接受任何新辅助治疗和接受任何辅助治疗的预测因素。
25073例患者纳入分析。患者接受NAC治疗（25.0%）、NCRT治疗（31.4%）、辅助化疗（6.5%）、辅助CRT治疗（12.6%）和单纯手术治疗（24.5%）。与2006 - 2011年相比，2012年至2017年诊断的患者中，接受NAC治疗（18.6%对29.0%；p < 0.001）和NCRT治疗（25.0%对35.5%；p < 0.001）的增幅最大。中位总生存期为44.9个月。与仅接受辅助治疗或手术的患者相比，接受任何新辅助治疗的患者总生存期最长（分别为51.0个月、42.4个月和38.0个月；p < 0.001）。黑人患者、收入处于最低四分位数的患者或在治疗量较低的机构接受治疗的患者接受新辅助治疗的可能性较小（所有p < 0.001）。
GA新辅助治疗的使用显著加速。目前，在美国最常见的治疗顺序是NCRT后手术。需要进一步的试验来进一步确定最佳治疗顺序。
