Masuike Yasunori, Omori Takeshi, Yamamoto Kazuyoshi, Yanagimoto Yoshitomo, Ushimaru Yuki, Yamamoto Kei, Kanemura Takashi, Sugase Takahito, Matsuura Norihiro, Mori Ryota, Kitakaze Masatoshi, Kubo Masahiko, Fukuda Yasunari, Komatsu Hisateru, Miyo Masaaki, Sueda Toshinori, Kagawa Yoshinori, Goto Kunihito, Kobayashi Shogo, Ohue Masayuki, Miyata Hiroshi
Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka-Shi, Osaka-Fu, 5418567, Japan.
Int J Clin Oncol. 2025 Aug 27. doi: 10.1007/s10147-025-02867-2.
Conversion surgery following systemic chemotherapy has emerged as a promising strategy for clinical stage IV gastric cancer. However, the role of postoperative chemotherapy in improving survival outcomes remains unclear. This study aimed to evaluate the impact of postoperative chemotherapy on survival, comparing single-agent and combination regimens.
We conducted a single-institution retrospective study of patients who underwent gastrectomy after induction chemotherapy for clinical stage IV gastric cancer between 2007 and 2021. Patients receiving postoperative chemotherapy were categorized into single-agent and combination therapy groups. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier curves and Cox proportional hazard models. Propensity score matching was applied to minimize selection bias.
Among 128 eligible patients, 45 (35.2%) received single-agent chemotherapy, while 83 (64.8%) received combination therapy. After propensity score matching, 70 patients (35 in each group) were analyzed. The median OS was 29 months, and the median PFS was 14 months, with no significant differences between single-agent and combination chemotherapy groups (OS: p = 0.841; PFS: p = 0.831). Residual tumor was a strong predictor of poor survival (p = 0.010). Subgroup analysis suggested a potential PFS benefit of combination therapy in ypStage IV patients without residual tumor (p = 0.04).
Postoperative combination chemotherapy did not significantly improve survival outcomes compared with single-agent regimen in the overall cohort. However, specific subgroups, particularly ypStage IV patients without residual tumor, may benefit from intensified therapy.
全身化疗后的转化手术已成为临床IV期胃癌的一种有前景的治疗策略。然而，术后化疗在改善生存结局方面的作用仍不明确。本研究旨在评估术后化疗对生存的影响，比较单药和联合方案。
我们对2007年至2021年间因临床IV期胃癌接受诱导化疗后行胃切除术的患者进行了单机构回顾性研究。接受术后化疗的患者分为单药治疗组和联合治疗组。采用Kaplan-Meier曲线和Cox比例风险模型分析总生存期（OS）和无进展生存期（PFS）。应用倾向评分匹配以尽量减少选择偏倚。
在128例符合条件的患者中，45例（35.2%）接受单药化疗，83例（64.8%）接受联合治疗。倾向评分匹配后，分析了70例患者（每组35例）。中位OS为29个月，中位PFS为14个月，单药化疗组和联合化疗组之间无显著差异（OS：p = 0.841；PFS：p = 0.831）。残留肿瘤是生存不良的有力预测因素（p = 0.010）。亚组分析表明，对于无残留肿瘤的ypIV期患者，联合治疗可能有PFS获益（p = 0.04）。
在整个队列中，与单药方案相比，术后联合化疗并未显著改善生存结局。然而，特定亚组，特别是无残留肿瘤的ypIV期患者，可能从强化治疗中获益。
