Leng Albert, Madan Vrinda, Shah Manuj, Gurau Andrei, Johnston Fabian M, Greer Jonathan B
Division of Gastrointestinal Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2025 Mar;32(3):2122-2128. doi: 10.1245/s10434-024-16408-0. Epub 2024 Dec 29.
The standard of care for gastric cancer in the United States involves perioperative chemotherapy. While most post-therapy pathologic staging results are concordant (i.e. ypTN or ypT0N0), patients occasionally display discordant results, such as ypT0N1. Herein, we characterized the survival of patients with ypT0N1 staging to better determine their categorization within the American Joint committee on Cancer (AJCC) staging system.
Using the National Cancer Database (NCDB), we queried all patients diagnosed with gastric adenocarcinoma from 2004 to 2021 who received neoadjuvant chemotherapy. Patients were stratified by their ypTNM stage: (1) ypT0N0; (2) ypT+N0; (3) ypT+N1; and (4) ypT0N1. Multivariable Cox proportional hazard regression was used to assess 5- and 10-year survival between ypTNM stages.
A total of 28,985 patients received neoadjuvant chemotherapy, of whom 2378 (8.2%) had ypT0N0, 9402 (32.4%) had ypT+N0, 5339 (18.4%) had ypT+N1, and 318 (1.1%) had ypT0N1 staging. Overall, patients had a median age of 64 years, with the majority being male (74.9%) or White (82.2%). Additionally, 50.2% received care from an academic center, and 53.3% received neoadjuvant chemotherapy and radiotherapy. On multivariable analysis, patients with ypT0N1 had a 105% higher risk for mortality within 5 years (adjusted hazards ratio [aHR] 2.05, 95% confidence interval [CI] 1.69-2.50) and 86% increased risk within 10 years (aHR 1.86, 95% CI 1.54-2.23) when compared with ypT0N0.
Patients with stage ypT0N1 disease have worse 5- and 10-year outcomes than those with node-negative disease. Thus, their survival pattern most closely matches patients with ypstage IIB and III disease.
美国胃癌的标准治疗方案包括围手术期化疗。虽然大多数治疗后病理分期结果是一致的（即ypTN或ypT0N0），但患者偶尔会出现不一致的结果，如ypT0N1。在此，我们对ypT0N1分期患者的生存率进行了特征分析，以更好地确定他们在美国癌症联合委员会（AJCC）分期系统中的分类。
利用国家癌症数据库（NCDB），我们查询了2004年至2021年期间所有诊断为胃腺癌并接受新辅助化疗的患者。患者按ypTNM分期进行分层：（1）ypT0N0；（2）ypT + N0；（3）ypT + N1；以及（4）ypT0N1。采用多变量Cox比例风险回归分析评估ypTNM各分期之间的5年和10年生存率。
共有28985例患者接受了新辅助化疗，其中2378例（8.2%）为ypT0N0，9402例（32.4%）为ypT + N0，5339例（18.4%）为ypT + N1，318例（1.1%）为ypT0N1分期。总体而言，患者的中位年龄为64岁，大多数为男性（74.9%）或白人（82.2%）。此外，50.2%的患者在学术中心接受治疗，53.3%的患者接受了新辅助化疗和放疗。多变量分析显示，与ypT0N0患者相比，ypT0N1患者5年内死亡风险高105%（调整后风险比[aHR] 2.05，95%置信区间[CI] 1.69 - 2.50），10年内死亡风险高86%（aHR 1.86，95% CI 1.54 - 2.23）。
ypT0N1期疾病患者的5年和10年预后比无淋巴结转移疾病患者更差。因此，他们的生存模式与ypIIB期和III期患者最为接近。
