Palaj Július, Kečkéš Štefan, Marek Víťezslav, Dyttert Daniel, Sabol Martin, Durdík Štefan, Waczulíková Iveta
Department of Surgical Oncology St. Elizabeth Cancer Institute, Heydukova 10, Bratislava, 812 50, Slovak Republic.
Faculty of Medicine in Bratislava of the Comenius University, Špitálska 24, Bratislava, 813-72, Slovak Republic.
Sci Rep. 2025 Apr 18;15(1):13381. doi: 10.1038/s41598-025-98656-y.
Conversion surgery (CS) following systemic chemotherapy (SCT) has been suggested as a promising strategy for improving prognosis of patients with advanced gastric carcinoma (GC). The evidence, however, comes mostly from small-scale studies. Moreover, controversy exists over the criteria for selecting patients for SCT. We retrospectively analyzed 123 patients treated between 2007 and 2023. Thirty-one underwent CS, 44 received primary radical surgery (R0) with adjuvant chemotherapy (ACT), and 48 received surgical or palliative treatment. Survival rates and predictors of successful conversion were assessed. Median survival for R0 + ACT (30.4 months, 95%CI: 20.9-45.0) was non-significantly higher than SCT + R0 (19.4 months, 95%CI: 10.3-40.1; P = 0.2353). Successful downstaging after SCT was observed in 54.8% of CS patients. This group of SCT responders had significantly lower laboratory markers CEA, NLR and PLR (P-value of 0.019; 0.036 and 0.029, respectively). Both successful and failed conversion groups had significantly longer survival than group with palliative treatment (16.0 months, 95%CI: 8.4-19.1 vs. 7.4 months, 95%CI: 5.3-9.9; P = 0.0003). Multivariable analysis confirmed significantly lowered hazard and prolonged overall survival in CS vs. palliative treatments after adjusting for age and stage differences (P = 0.0014). Conversion therapy improves short-term survival and offers potential for long-term survival in select stage IV GC patients.
全身化疗（SCT）后进行转化手术（CS）被认为是改善晚期胃癌（GC）患者预后的一种有前景的策略。然而，证据大多来自小规模研究。此外，在选择接受SCT的患者标准方面存在争议。我们回顾性分析了2007年至2023年期间接受治疗的123例患者。31例接受了CS，44例接受了根治性手术（R0）加辅助化疗（ACT），48例接受了手术或姑息治疗。评估了生存率和成功转化的预测因素。R0+ACT组的中位生存期（30.4个月，95%CI：20.9-45.0）略高于SCT+R0组（19.4个月，95%CI：10.3-40.1；P=0.2353），但差异无统计学意义。54.8%的CS患者在SCT后观察到成功降期。这组SCT反应者的实验室标志物癌胚抗原（CEA）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）显著较低（P值分别为0.019、0.036和0.029）。成功转化组和失败转化组的生存期均显著长于姑息治疗组（16.0个月，95%CI：8.4-19.1与7.4个月，95%CI：5.3-9.9；P=0.0003）。多变量分析证实，在调整年龄和分期差异后，CS与姑息治疗相比，风险显著降低，总生存期延长（P=0.0014）。转化治疗可改善部分IV期GC患者的短期生存并提供长期生存的潜力。
