| Shanhui Zhang,Fei Zhou,Donghai Liang,Hongying Lv,Hongsheng Yu. Benefit of adjuvant chemoradiotherapy in patients with pathologically lymph node-positive and locally advanced gastric cancer. Oncol Transl Med, 2020, 6: 72-80. |
| 淋巴结阳性的局部晚期胃癌患者辅助放化疗的益处 |
| Benefit of adjuvant chemoradiotherapy in patients with pathologically lymph node-positive and locally advanced gastric cancer |
| Received:March 26, 2020 Revised:May 14, 2020 |
| DOI：10.1007/s10330-020-0413-3 |
| 中文关键词: 局部晚期胃癌；放化疗；化疗；淋巴结阳性；生存预后 |
| 英文关键词: locally advanced gastric cancer; adjuvant chemoradiotherapy; adjuvant radiotherapy; lymph node-positive; survival and prognosis |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Shanhui Zhang | Qingdao University | shzhang0217@163.com | | Fei Zhou | Affiliated Hospital of Qingdao University | | | Donghai Liang | Department of oncology,Affiliated Hospital of Qingdao University | | | Hongying Lv | Department of oncology,Affiliated Hospital of Qingdao University | | | Hongsheng Yu* | Department of oncology,Affiliated Hospital of Qingdao University | hsyqd2019@163.com |
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| 中文摘要: |
| 目的：比较辅助放化疗与单纯化疗对D2根治术后局部晚期胃癌患者复发、生存的影响，探索术后辅助放化疗的临床价值。
方法：选择2010年06月至2014年06月在青岛大学附属医院行胃癌D2根治术的局部晚期（T3-4N+M0）患者192例作为研究对象，采用χ2检验比较辅助放化疗（CRT）组与单纯化疗（ChT）组患者的基线特征是否有统计学差异，通过对数秩检验比较两组总的复发、生存情况，并使用Kaplan-Meier方法将其绘制成生存曲线。采用χ2检验单独分析两组3年、5年无病生存率（DFS）、总生存率（OS）的差异。通过单变量和多变量分析确立影响复发、生存的预后因素。统计首次复发部位并分析复发模式。最后通过亚组分析进一步评估在不同亚组中，辅助放化疗与单纯化疗对胃癌患者复发、生存的影响。
结果：截止到随访结束，中位随访时间为54个月。192例患者中127例术后复发（CRT组为63例，ChT组为64例），126例死亡（两组各63例）。CRT组与ChT组3年无病生存率为52.9％ vs 36.7％（P = 0.024），5年无病生存率为41.2％ vs 31.1％（P = 0.148）。CRT组与ChT组3年总生存率为82.4％ vs 70.0％（P = 0.044），5年总生存率为52.0％ vs 35.6％（P = 0.022）。分析复发模式提示CRT组的局部区域复发率显著低于ChT组（P=0.031），腹膜转移或远处转移率两组无统计学差异。亚组分析发现淋巴结分期为N1-2的患者可以从辅助放化疗中获得无病生存率或总生存率的显著提高（P值均小于0.05）。
结论:局部晚期胃癌患者行D2根治术后复发风险高，预后差。与单纯化疗相比，接受辅助放化疗的患者在无病生存和总生存上显著获益。亚组分析发现，对于淋巴结分期为N1-2的患者，辅助放化疗在无病生存和总生存方面显著优于单纯化疗。 |
| 英文摘要: |
| Objective This study aimed to compare the effectiveness of adjuvant chemoradiotherapy (CRT) and
adjuvant chemotherapy (ChT) for T3–4/N+ gastric cancer (GC) following D2/R0 dissection, and identify the
specific subgroups that could benefit from adjuvant CRT.
Methods All eligible patients were divided into the CRT group and ChT group. We assessed the survival
outcomes and patterns of recurrence for each group, and determined the prognostic factors for survival by
performing Cox proportional risk regression analyses.
Results A total of 192 gastric cancer patients were included in the study. The estimated 3-year and 5-year
disease-free survival (DFS) probabilities in the CRT and ChT groups were 52.9% vs. 36.7% (P = 0.024)
and 41.2% vs. 31.1% (P = 0.148), respectively, and the estimated 3-year and 5-year overall survival (OS)
probabilities were 82.4% vs. 70.0% (P = 0.044) and 52.0% vs. 35.6% (P = 0.022). Patients in the CRT group
had a lower risk of locoregional recurrence than those in the ChT group (20.6% vs. 34.4%; P = 0.031). The
subset analyses revealed that patients with stage N1–2 disease were more likely to benefit from adjuvant
CRT than from adjuvant ChT (DFS: 53.1% vs. 36.4%; P = 0.039; OS: 53.1% vs. 38.6%; P = 0.036).
Conclusion For locally advanced gastric cancer patients with LN+, adjuvant CRT showed superior
survival benefits compared with adjuvant ChT alone. Patients with N1–2 achieved better survival from
adjuvant CRT. |
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