Xing Jiyao, Wang Yinkui, Cao Min, Shan Fei, Li Shuangxi, Jia Yongning, Xue Kan, Miao Rulin, Li Zhemin, Yan Chao, Li Shen, Wu Zhouqiao, Gao Xiangyu, Zhang Yan, Ji Jiafu, Li Ziyu
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
Eur J Surg Oncol. 2025 Aug;51(8):109752. doi: 10.1016/j.ejso.2025.109752. Epub 2025 Mar 7.
Neoadjuvant chemotherapy (NAC) is a standard treatment for locally advanced gastric cancer, but its efficacy for Scirrhous-type Gastric Cancer (SGC) remains uncertain. This study evaluated the effectiveness of NAC and identified characteristics of potential beneficiaries within this patient population.
A retrospective single-center analysis included patients with large SGC who underwent either NAC followed by surgery (NAC group) or upfront surgery (SUR group). Kaplan-Meier methods and Cox regression were used for survival analysis. Causal survival forest (CSF) models assessed individual treatment effects (ITE) and treatment heterogeneity. Survival differences were validated in potential beneficiaries based on CSF-derived criteria.
The study included 60 patients in SUR group and 79 in NAC group. The 5-year overall survival (OS) rates were 39.2 % for the SUR group and 40.9 % for the NAC group (p = 0.53). CSF analysis revealed heterogeneity in ITE, with BMI, age, and distal gastric tumors associated with ITE. In the subgroup of patients younger than 58 years with a BMI <25.9 kg/m (benefit group), the 5-year OS rate was significantly higher in the NAC group (47.7 % vs. 22.9 %; HR = 0.428, 95 % CI: 0.205-0.892; p = 0.023). Further restricting the analysis to distal gastric cancer reduced the HR for NAC (HR = 0.299, 95 % CI: 0.094-0.959; p = 0.033).
NAC efficacy for large SGCs shows significant heterogeneity. Patients younger than 58 years, with a BMI <25.9 kg/m and distal tumors may derive survival benefits from NAC.
新辅助化疗（NAC）是局部晚期胃癌的标准治疗方法，但其对硬癌型胃癌（SGC）的疗效仍不确定。本研究评估了NAC的有效性，并确定了该患者群体中潜在受益人的特征。
一项回顾性单中心分析纳入了患有大型SGC的患者，这些患者接受了NAC后手术（NAC组）或直接手术（SUR组）。采用Kaplan-Meier方法和Cox回归进行生存分析。因果生存森林（CSF）模型评估个体治疗效果（ITE）和治疗异质性。根据CSF得出的标准在潜在受益人中验证生存差异。
该研究包括SUR组60例患者和NAC组79例患者。SUR组的5年总生存率（OS）为39.2%，NAC组为40.9%（p = 0.53）。CSF分析显示ITE存在异质性，BMI、年龄和远端胃肿瘤与ITE相关。在BMI<25.9kg/m的58岁以下患者亚组（受益组）中，NAC组的5年OS率显著更高（47.7%对22.9%；HR = 0.428，95%CI：0.205 - 0.892；p = 0.023）。将分析进一步限制于远端胃癌降低了NAC的HR（HR = 0.299，95%CI：0.094 - 0.959；p = 0.033）。
NAC对大型SGC的疗效显示出显著异质性。年龄小于58岁、BMI<25.9kg/m且患有远端肿瘤的患者可能从NAC中获得生存益处。
