中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2021, Vol. 43 ›› Issue (4): 571-578.doi: 10.3881/j.issn.1000-503X.13260

• 论著 • 上一篇    下一篇

新辅助治疗胃癌病理完全缓解的影响因素及预后分析

王童博1,周红1,张晓杰1,孙崇源1,郭春光1,陈应泰1,周爱萍2(),金晶3(),赵东兵1()   

  1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院 北京协和医学院 肿瘤医院 1胰胃外科,北京 100021
    2肿瘤内科,北京 100021
    3放疗科,北京 100021
  • 收稿日期:2020-08-07 出版日期:2021-08-30 发布日期:2021-09-03
  • 通讯作者: 周爱萍,金晶,赵东兵 E-mail:zhouap1825@126.com;jingjin1025@163.com;dbzhao2003@sina.com
  • 基金资助:
    中国癌症基金会北京希望马拉松专项基金(LC2017L01)

Prognosis and Related Factors of Patients with Pathological Complete Response after Neoadjuvant Therapy for Gastric Cancer

WANG Tongbo1,ZHOU Hong1,ZHANG Xiaojie1,SUN Chongyuan1,GUO Chunguang1,CHEN Yingtai1,ZHOU Aiping2(),JIN Jing3(),ZHAO Dongbing1()   

  1. 1Department of Pancreatic and Gastric Surgical Oncology,Beijing 100021,China
    2Department of Medical Oncology,Beijing 100021,China
    3Department of Radiation Oncology,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,CAMS and PUMC,Beijing 100021,China
  • Received:2020-08-07 Published:2021-08-30 Online:2021-09-03
  • Contact: ZHOU Aiping,JIN Jing,ZHAO Dongbing E-mail:zhouap1825@126.com;jingjin1025@163.com;dbzhao2003@sina.com
  • Supported by:
    Beijing Hope Run Special Fund of Cancer Foundation of China(LC2017L01)

摘要:

目的 探讨新辅助治疗后胃癌病理完全缓解(pCR)的相关影响因素并分析患者预后的影响因素。方法 回顾性分析 2008年1至12月新辅助治疗胃癌根治术490例患者的临床病理资料,对影响胃癌病理完全缓解及预后的风险因素进行单因素和多因素分析。结果 纳入的490例患者中41例达到pCR,pCR率为8.3%(41/490)。新辅助放化疗组pCR率为16.0%,新辅助化疗组为6.4%。多因素分析显示新辅助放化疗(OR=4.401,95%CI=2.023~9.574,P<0.001)、术前治疗疗效为部分缓解(OR=40.492,95%CI=5.366~305.572,P<0.001)是新辅助治疗后pCR的独立预测因素。预后多因素分析显示,肿瘤呈低分化(HR=1.809,95%CI=1.104~2.964,P=0.019)、贲门-胃底-胃体部肿瘤(HR=2.025,95%CI=1.497~2.739,P<0.001)、术中清扫淋巴结≤15枚(HR=1.482,95%CI=1.059~2.073,P=0.022)、术后出现并发症(HR=1.625,95%CI=1.156~2.285,P=0.005)是新辅助治疗后行胃癌根治术患者预后的独立危险因素,而术后病理达到完全缓解(HR=0.153,95%CI=0.048~0.484,P=0.001)及术后接受辅助化疗(HR=0.589,95%CI=0.421~0.823,P<0.001)是患者预后的独立保护因素。结论 新辅助治疗后获得pCR的局部进展期胃癌患者可以获得满意的远期生存,并且是患者预后的独立预测因素。相较于单纯化疗,术前放化疗可以显著提高局部进展期胃癌的pCR率。

关键词: 局部进展期胃癌, 新辅助治疗, 病理完全缓解, 胃癌根治术, 预后

Abstract:

Objective To investigate the related factors of pathological complete response(pCR)of patients with gastric cancer treated by neoadjuvant therapy and resection,and to analyze the risk factors of prognosis. Methods The clinical and pathological data of 490 patients with gastric cancer who received neoadjuvant therapy followed by radical gastrectomy from January to December in 2008 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify the risk factors affecting pCR and prognosis. Results Among the 490 patients,41 achieved pCR,and the overall pCR rate was 8.3%(41/490).The pCR rate was 16.0% in the neoadjuvant chemoradiation group and 6.4% in the neoadjuvant chemotherapy group.The results of multivariate analysis showed that neoadjuvant chemoradiation(OR=4.401,95% CI=2.023-9.574,P<0.001)and preoperative therapeutic response as partial response(OR=40.492,95% CI=5.366-305.572,P<0.001)were independent predictors of pCR after neoadjuvant therapy.Multivariate analysis of prognosis showed that poorly differentiated tumor(HR=1.809,95% CI=1.104-2.964,P=0.019),gastric cardia-fundus-body tumor(HR=2.025,95% CI=1.497-2.739,P<0.001),≤15 intraoperative dissected lymph nodes(HR=1.482,95% CI=1.059-2.073,P=0.022),and postoperative complications(HR=1.625,95% CI=1.156-2.285,P=0.005)were independent risk factors for prognosis,while pCR(HR=0.153,95% CI=0.048-0.484,P=0.001)and postoperative adjuvant chemotherapy(HR=0.589,95% CI=0.421-0.823,P<0.001)were independent protective factors of prognosis. Conclusions Patients who achieved pCR after neoadjuvant therapy for locally advanced gastric cancer might have promising long-term survival,and pCR is an independent predictor for overall survival.Compared with chemotherapy alone,preoperative chemoradiotherapy can significantly improve the pCR rate of patients with locally advanced gastric cancer.

Key words: locally advanced gastric cancer, neoadjuvant therapy, pathological complete response, radical gastrectomy, prognosis

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