曲妥珠单抗为基础的化疗和免疫治疗后IV期HER2阳性胃癌的转化手术：一项回顾性多中心队列研究

Conversion Surgery After Trastuzumab-Based Chemotherapy and Immunotherapy for Stage IV HER2-Positive Gastric Cancer: A Retrospective Multicenter Cohort Study.

作者信息

Liang Huayuan, Liang Chengcai, Zhang Jiaguang, Sun Xiaowen, Huang Kaihua, Zhang Huimin, Li Guoxin, Chen Xiaofeng, Zhao Liying

机构信息

Cancer Center of Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.

State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.

出版信息

Ann Surg Oncol. 2025 Jun 26. doi: 10.1245/s10434-025-17729-4.

DOI:10.1245/s10434-025-17729-4

PMID:40571894

Abstract

BACKGROUND

The efficacy and safety of conversion surgery after immunotherapy combined with trastuzumab-based chemotherapy for patients with stage IV human epidermal growth factor receptor 2 (HER2)-positive gastric cancer (GC) remains unclear.

METHODS

This retrospective multicenter study included patients with stage IV HER2-positive GC treated between February 2012 and October 2024 across three centers in China. Eligible patients had histologically confirmed HER2-positive GC with unresectable stage IV disease treated with trastuzumab-based chemotherapy and/or immunotherapy. Conversion surgery was performed for patients who achieved substantial tumor shrinkage enabling R0 resection.

RESULTS

Among 232 patients, 114 received chemotherapy combined with trastuzumab alone, whereas 118 were treated with chemotherapy plus immunotherapy and trastuzumab, 50 of whom subsequently underwent conversion surgery. In the cohort receiving chemotherapy and trastuzumab alone, the median progression-free survival (PFS) was 8.2 months (95 % confidence interval [CI], 6.2-10.2 months), and the median overall survival (OS) was 13.9 months (95 % CI, 10.8-17.1 months). The patients who underwent conversion surgery exhibited significantly longer PFS (37.7 vs 10.8 months; P < 0.001) and OS (50.9 vs 22.0 months; P < 0.001) than the non-surgical patients treated with immunotherapy.

CONCLUSIONS

Preoperative trastuzumab-based chemotherapy combined with immunotherapy followed by conversion surgery significantly improves survival outcomes for patients with stage IV HER2-positive GC.

摘要

背景

免疫疗法联合曲妥珠单抗为基础的化疗用于IV期人表皮生长因子受体2（HER2）阳性胃癌（GC）患者的转化手术的疗效和安全性仍不明确。

方法

这项回顾性多中心研究纳入了2012年2月至2024年10月在中国三个中心接受治疗的IV期HER2阳性GC患者。符合条件的患者经组织学证实为HER2阳性GC，伴有不可切除的IV期疾病，接受曲妥珠单抗为基础的化疗和/或免疫疗法。对实现肿瘤大幅缩小从而能够进行R0切除的患者进行转化手术。

结果

在232例患者中，114例仅接受化疗联合曲妥珠单抗，而118例接受化疗加免疫疗法和曲妥珠单抗治疗，其中50例随后接受了转化手术。在仅接受化疗和曲妥珠单抗的队列中，中位无进展生存期（PFS）为8.2个月（95%置信区间[CI]，6.2 - 10.2个月），中位总生存期（OS）为13.9个月（95%CI，10.8 - 17.1个月）。接受转化手术的患者的PFS（37.7个月对10.8个月；P < 0.001）和OS（50.9个月对22.0个月；P < 0.001）显著长于接受免疫疗法的非手术患者。