Li Zefeng, Sun Chongyuan, Fei He, Li Zheng, Zhao Dongbing, Guo Chunguang, Du Chunxia
Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Surg Oncol. 2025 Jan;32(1):342-350. doi: 10.1245/s10434-024-16365-8. Epub 2024 Oct 24.
Perioperative chemotherapy is the standard treatment modality for locally advanced gastric cancer. However, the efficacy and indication of adjuvant chemotherapy in patients who have already received neoadjuvant chemotherapy remain unclear. This study aims to explore the association between adjuvant chemotherapy with patient prognosis in those who have received neoadjuvant chemotherapy plus D2 gastrectomy in a real-world setting, and whether this association is affected by the duration of neoadjuvant treatment.
A total of 174 patients with cT3-4N+ gastric cancer who had received neoadjuvant chemotherapy plus D2 radical gastrectomy were included in the study. Kaplan-Meier curves and log-rank tests were used to assess and compare the survival outcomes between patients who received adjuvant therapy and those who did not.
Patients who were younger age, had a lower American Society of Anesthesiologists (ASA) grade, did not experience postoperative complication, and received fewer than six cycles of neoadjuvant chemotherapy were more likely to receive adjuvant chemotherapy, rather than those with advanced ypTNM stage or poor tumor regression grade. Patients who received adjuvant therapy had a better overall survival (OS) (2-year OS rate 86.2% versus 64.1%, p = 0.002). Adjuvant therapy was associated with longer survival in patients who remained ypTNM stage III despite receiving at least six cycles of neoadjuvant chemotherapy. However, there was no significant longer survival observed in patients with ypTNM stages 0-II receiving adjuvant chemotherapy, even when they received less than six cycles of neoadjuvant chemotherapy.
Patients with locally advanced gastric cancer may still need adjuvant chemotherapy, even after receiving neoadjuvant chemotherapy. The value of adjuvant chemotherapy after neoadjuvant chemotherapy depends more on the actual downstaging effect achieved after neoadjuvant chemotherapy, rather than the completion of "full intended" cycles of perioperative treatment.
围手术期化疗是局部晚期胃癌的标准治疗方式。然而，对于已经接受新辅助化疗的患者，辅助化疗的疗效和适应证仍不明确。本研究旨在探讨在真实世界中，接受新辅助化疗加D2胃切除术的患者接受辅助化疗与患者预后之间的关联，以及这种关联是否受新辅助治疗持续时间的影响。
本研究纳入了174例接受新辅助化疗加D2根治性胃切除术的cT3-4N+胃癌患者。采用Kaplan-Meier曲线和对数秩检验来评估和比较接受辅助治疗和未接受辅助治疗患者的生存结局。
年龄较轻、美国麻醉医师协会（ASA）分级较低、未发生术后并发症且接受少于6周期新辅助化疗的患者比ypTNM分期较晚或肿瘤退缩分级较差的患者更有可能接受辅助化疗。接受辅助治疗的患者总生存期（OS）更好（2年OS率86.2%对64.1%，p = 0.002）。对于尽管接受了至少6周期新辅助化疗但仍为ypTNM III期的患者，辅助治疗与更长的生存期相关。然而，对于ypTNM 0-II期接受辅助化疗的患者，即使他们接受的新辅助化疗少于6周期，也未观察到显著更长的生存期。
局部晚期胃癌患者即使接受了新辅助化疗，可能仍需要辅助化疗。新辅助化疗后辅助化疗的价值更多地取决于新辅助化疗后实际达到的降期效果，而不是围手术期治疗“完整计划”周期的完成情况。
