Leijonmarck Wilhelm, Mattsson Fredrik, Lagergren Jesper
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Retzius Street 13A, 4th Floor, 171 77, Stockholm, Sweden.
School of Cancer and Pharmacological Sciences, King's College London, London, UK.
Gastric Cancer. 2025 Jan;28(1):96-101. doi: 10.1007/s10120-024-01558-7. Epub 2024 Oct 10.
Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.
This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.
Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46-0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56-1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56-1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.
Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.
化疗的远期效应可能影响癌症幸存者的死亡率。本研究旨在明确胃腺癌新辅助化疗是否会影响已治愈该肿瘤患者的长期生存。
这是一项基于全国人群的队列研究，纳入了2006年至2015年间在瑞典因胃腺癌接受胃切除术且术后存活≥5年的所有个体。对该队列进行随访直至死亡或研究期结束（2020年12月31日）。采用多变量Cox比例风险回归分析以提供风险比（HR）及95%置信区间（CI）。HR针对年龄、性别、合并症、教育程度、日历年份、肿瘤亚部位、院内并发症及脾切除术进行了校正。数据来源于医疗记录和全国登记册。
在613名胃腺癌幸存者中，新辅助化疗（269例患者使用，占43.9%）与粗死亡率降低相关（HR 0.66，95% CI 0.46 - 0.96）。然而，在对所有混杂因素进行校正后（HR 0.83，95% CI 0.56 - 1.23）以及仅对年龄和合并症进行校正后（HR 0.82，95% CI 0.56 - 1.20），该关联减弱且无统计学意义。分层分析未显示新辅助化疗与年龄、性别、合并症、日历年份及肿瘤亚部位类别中的长期死亡率之间存在任何统计学显著关联。
新辅助化疗并未降低胃腺癌幸存者的长期生存率。接受新辅助化疗的患者是一个经过筛选的群体，其特点是年龄较轻且严重合并症较少，因此长期生存机会更好。
