Lauren分型与局部进展期胃癌术前放化疗后肿瘤病理反应相关性分析

目的探讨Lauren分型与局部进展期胃腺癌术前放化疗后肿瘤病理反应相关性。方法选取2013-2019年间中山大学肿瘤防治中心多中心Ⅲ期研究中98例患者,入组患者均有明确的Lauren分型并完成术前放化疗(CRT,46例)或术前化疗(ChT,52例)以及根治手术。分析术前治疗后肿瘤消退分级(NCCN-TRG0-3)、转移淋巴结分期(ypN0-3期)与患者Lauren分型的相关性。病理反应良好(FPR)定义为同时达到TRG0-2和ypN0。结果CRT组中肠型患者比非肠型患者有较高的ypN0率(OR=6.8,95%CI为1.8~25.0,P=0.004)和FPR率(OR=8.0,95%CI为2.2~29.9,P=0.002),而ChT组中Lauren分型则与病理反应无关(P>0.05)。肠型患者中接受术前放化疗患者的病理消退反应率均显著高于术前化疗患者(TRG0-2P=0.033;ypN0P<0.001;FPR P<0.001),而非肠型患者的术后病理反应则与术前治疗方式无关(P>0.05)。结论Lauren分型有可能作为局部进展期胃癌术前放化疗疗效良好的预测因子,并可借以选择、优化术前治疗方式。

The relationship between Lauren classification and pathological response after preoperative chemoradiotherapy for locally advanced gastric cancer

Objective To investigate the correlation between Lauren classification and pathological response after preoperative chemoradiotherapy in patients with locally advanced gastric cancer. Methods From 2013 to 2019,98 patients with definite Lauren classification who were enrolled in Sun Yat-sen University Cancer Center 5010 Phase Ⅲ clinical trials. Among them, 46 patients received preoperative chemoradiotherapy (CRT), and the remaining 52 cases received preoperative chemotherapy (ChT) and radical surgery. After preoperative therapy, the correlation between pathological responseincluding the tumor regression grade (NCCN-TRG0-3) and the lymph node stage (ypN0-3) and Lauren classification was analyzed. A favorable pathological response (FPR) was defined as TRG0-2 and ypN0. Results In the CRT group, patients with intestinal type (IT) tumors had a higher rate of ypN0(OR=6.8,95%CI:1.8-25.0,P=0.004) and FPR (OR=8.0,95%CI:2.2-29.9,P=0.002) than their counterparts with diffuse or mixed type tumors. However, Lauren classification was not significantly correlated withpathological responsein the ChT group (P>0.05). For patients with IT tumors, those receiving CRT had a higher likelihood of achieving a TRG0-2 response (P=0.033), an ypN0 nodal regression (P<0.001), and a FPR (P<0.001) than their counterparts receiving ChT, whereas pathological response was not significantly associated with preoperative therapeutic method in patients with diffuse or mixed tumors (P>0.05). Conclusion Lauren classification may be a reliable predictor of the clinical efficacy of preoperative chemoradiotherapy for locally advanced gastric cancer, which can be utilized to select and optimize preoperative treatment.