Nishikawa Kazuhiro, Koizumi Wasaburo, Tsuburaya Akira, Suzuki Motoko, Morita Satoshi, Fujitani Kazumasa, Akamaru Yusuke, Shimada Ken, Hosaka Hisashi, Nishimura Ken, Yoshikawa Takaki, Tsujinaka Toshimasa, Sakamoto Junichi
Cancer Treatment Center OsakaInternational Medical & Science Center, Osaka Keisatsu Hospital Osaka Japan.
Kitasato University Sagamihara Kanagawa Japan.
Ann Gastroenterol Surg. 2024 Nov 4;9(3):429-438. doi: 10.1002/ags3.12880. eCollection 2025 May.
Second-line chemotherapy (SLC) improves survival in advanced gastric cancer (AGC). Although many patients receiving SLC have undergone gastrectomy, the impact of gastrectomy on SLC remains unclear.
The objective was to evaluate the impact of gastrectomy on SLC for AGC. A total of 290 eligible patients registered in two randomized phase III trials evaluating SLC for patients with AGC was classified into the prior gastrectomy group (PGG; = 187) or the no gastrectomy group (NGG; = 103). We compared overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and safety between these two groups. Adjusted OS and adjusted PFS were estimated using inverse probability of treatment weighting (IPTW).
The PGG had better performance status ( = 0.001), more prior platinum agent ( < 0.001), and more frequent peritoneal metastasis ( = 0.006) than the NGG. The PGG had significantly better OS (13.8 vs. 9.3 mo; hazard ratio [HR]: 0.59; < 0.001) and PFS (4.7 vs. 2.8 mo; HR: 0.58; < 0.001) than the NGG. The PGG had significantly better adjusted OS (13.8 vs. 10.0 mo; IPTW HR: 0.66; = 0.01) and adjusted PFS (4.3 vs. 3.2 mo; IPTW HR: 0.71; = 0.027) than the NGG. No significant differences were observed in ORR and DCR. The incidence of Grade 3 or worse adverse events did not differ between the two groups except for a high incidence of anemia and diarrhea in the NGG.
Patients with previous gastrectomy are expected to have better survival outcomes when receiving second-line irinotecan (IRI)-based chemotherapy for AGC.
二线化疗（SLC）可提高晚期胃癌（AGC）患者的生存率。尽管许多接受SLC的患者已经接受了胃切除术，但胃切除术对SLC的影响仍不清楚。
目的是评估胃切除术对AGC患者SLC的影响。在两项评估AGC患者SLC的随机III期试验中登记的290例符合条件的患者被分为先前胃切除组（PGG；n = 187）或未胃切除组（NGG；n = 103）。我们比较了这两组患者的总生存期（OS）、无进展生存期（PFS）、总缓解率（ORR）、疾病控制率（DCR）和安全性。采用治疗权重逆概率法（IPTW）估计调整后的OS和调整后的PFS。
与NGG相比，PGG患者的体能状态更好（P = 0.001），先前使用铂类药物的频率更高（P < 0.001），腹膜转移更频繁（P = 0.006）。PGG患者的OS（13.8个月对9.3个月；风险比[HR]：0.59；P < 0.001）和PFS（4.7个月对2.8个月；HR：0.58；P < 0.001）均显著优于NGG。PGG患者的调整后OS（13.8个月对10.0个月；IPTW HR：0.66；P = 0.01）和调整后PFS（4.3个月对3.2个月；IPTW HR：0.71；P = 0.027）也显著优于NGG。ORR和DCR未观察到显著差异。除NGG中贫血和腹泻的发生率较高外，两组3级或更严重不良事件的发生率无差异。
对于AGC患者，接受基于伊立替康（IRI）的二线化疗时，先前接受过胃切除术的患者有望获得更好的生存结果。
