Back Johan, Sallinen Ville, Bonsdorff Akseli, Kokkola Arto, Puolakkainen Pauli
Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Tower Hospital, Building 1, Haartmaninkatu 4, PO Box 340, Helsinki, 00029 HUS, Finland.
Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
BMC Surg. 2025 Apr 28;25(1):184. doi: 10.1186/s12893-025-02919-4.
Despite radical surgery, gastric cancer (GC) survival rates remain low in Western countries. Randomised trials suggest that perioperative chemotherapy downstages disease, improving long-term survival without increasing complications. We compared outcomes for upfront surgery (US) versus surgery combined with perioperative EOX (epirubicin, oxaliplatin, capecitabine) therapy for short- and long-term survival.
We analysed 310 patients who underwent curative intent gastrectomy for GC at a single tertiary centre from 2006 to 2017. Patients were assigned to the EOX group (n = 105) or the US group (n = 205). Propensity score matching (PSM) was utilised to balance baseline characteristics, clinical stage, surgery type, and histology. Short-term outcomes included the Comprehensive Complication Index (CCI) and 30-day mortality, while long-term outcomes were overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS).
After PSM, 102 patients remained in each group. The EOX group exhibited significantly lower preoperative haemoglobin levels compared to the US group, but other baseline characteristics were comparable. Tumour-related outcomes favoured the EOX group, with significantly smaller tumours (P < 0.001), fewer metastatic lymph nodes (P = 0.004), and lower tumour stages overall. Splenectomy was more common in the US group (40.2% versus 23.5%, P = 0.011). Postoperative complications were similar between groups, although ICU admissions were more frequent in the EOX group (16.7% versus 6.9%, P = 0.030). Thirty-day mortality rates were low and comparable (1.0% in the EOX group versus 2.0% in the US group, P = 1.000). Long-term outcomes, including overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS), showed no significant differences between the groups.
Perioperative EOX therapy is as safe as upfront surgery and significantly reduces metastatic lymph nodes and tumour size, suggesting its role in downstaging the disease. However, despite these promising oncological responses, this benefit does not translate into improved long-term survival.
尽管进行了根治性手术，但西方国家胃癌（GC）的生存率仍然很低。随机试验表明，围手术期化疗可使疾病降期，在不增加并发症的情况下提高长期生存率。我们比较了直接手术（US）与手术联合围手术期EOX（表柔比星、奥沙利铂、卡培他滨）治疗的短期和长期生存结果。
我们分析了2006年至2017年在单一三级中心接受根治性胃癌切除术的310例患者。患者被分配到EOX组（n = 105）或US组（n = 205）。采用倾向评分匹配（PSM）来平衡基线特征、临床分期、手术类型和组织学。短期结果包括综合并发症指数（CCI）和30天死亡率，而长期结果是总生存（OS）、疾病特异性生存（DSS）和无病生存（DFS）。
PSM后，每组各有102例患者。与US组相比，EOX组术前血红蛋白水平显著较低，但其他基线特征具有可比性。肿瘤相关结果有利于EOX组，肿瘤明显更小（P < 0.001），转移淋巴结更少（P = 0.004），总体肿瘤分期更低。脾切除术在US组更常见（40.2%对23.5%，P = 0.011）。两组术后并发症相似，尽管EOX组入住重症监护病房的频率更高（16.7%对6.9%，P = 0.030）。30天死亡率较低且具有可比性（EOX组为1.0%，US组为2.0%，P = 1.000）。长期结果，包括总生存（OS）、疾病特异性生存（DSS）和无病生存（DFS），两组之间无显著差异。
围手术期EOX治疗与直接手术一样安全，并显著减少转移淋巴结和肿瘤大小，表明其在使疾病降期方面的作用。然而，尽管有这些有前景的肿瘤学反应，但这种益处并未转化为改善的长期生存。
