Oncol2012: 术中全身性静脉化疗对可根治性切除的局部进展期胃癌患者预后的影响

背景: 尽管实行根治性切除术,局部进展期胃癌患者的预后仍然较差。 很少有研究报告关于术中全身性静脉化疗对胃癌的治疗作用。本研究目标是为了分析可切除的局部进展期胃癌患者的预后因素，重点是研究术中全身性静脉化疗对可切除的局部进展期胃癌患者预后的影响和其安全性。 方法: 收集2002-2007年中国医学科学院北京协和医院局部进展期胃癌根治手术患者264例，回顾性分析患者的临床病理及治疗资料。采用Kaplan-Meier法绘制患者的生存曲线。生存曲线差别比较采用log-rank法，单因素及多因素分析采用Cox 比例风险模型。 结果: 接受术中静脉全身性化疗的患者五年总生存时间较未进行术中静脉全身性化疗的患者明显升高(53.0% versus 37.3%, P=0.019), 同样接受术中静脉全身性化疗的患者五年无病生存时间较未进行术中静脉全身性化疗的患者也明显升高(48.3% versus 35.8%, P=0.010)。 在亚组分析中发现术中静脉化疗使pTNMIB-II期，pTNMIIIA-B期患者OS和DFS受益，但是对TNMIIIC期无明显作用。术中静脉化疗联合术后化疗患者较单纯术后静脉化疗患者的OS和DFS好（P=0.046 vs. P=0.021)。但是单纯术中静脉化疗组患者的OS和DFS较单纯手术组患者的改善作用未达到统计学差异(P=0.150 vs. P=0.170)。多因素分析显示术中全身性静脉化疗 是5年总生存时间和无病生存时间的独立的有益预后因素(P=0.048和P=0.023）。同时研究发现术后4周内没有与术中全身性静脉化疗相关的严重毒性发生。 结论: 术中全身性静脉化疗可使根治性切除的局部进展期胃癌患者(pTNM IB-IIIB)无病生存时间和总生存时间受益。

Benefits of Intraoperative Systemic Chemotherapy during Curative Surgery for Patients with Locally Advanced Gastric Cancer

Background: There is little information on the impact of intraoperative systemic chemotherapy on gastric cancer. The aim of this study was to identify prognostic factors in patients with locally advanced gastric cancer undergoing curative resection, with a focus on evaluating the survival benefit and tolerance of intraoperative systemic chemotherapy. Methods: We retrospectively analyzed clinicopathological data for 264 consecutive patients who underwent curative resection for gastric cancer at Peking Union Medical College Hospital from January 2002 to January 2007. Survival curves were plotted using the Kaplan-Meier method and compared using log-rank tests. Univariate and multivariate analyses were performed with the Cox proportional hazard model. Results: Patients who received intraoperative systemic chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.019 and 0.010, respectively) than those of patients who did not receive intraoperative systemic chemotherapy. In the subgroup analysis, systemic intraoperative chemotherapy benefited the 5-year overall survival and disease-free survival rates of patients with stage pTNM IB-IIIB, but not stage pTNM IIIC, cancer. Patients who received intraoperative systemic chemotherapy in combination with postoperative chemotherapy had higher 5-year overall survival and 5-year disease-free survival rates (P = 0.046 and 0.021, respectively) than those of patients who only received postoperative chemotherapy. However, the difference in these rates between patients who received only intraoperative systemic chemotherapy and patients who only received curative surgery was not statistically significant (P = 0.150 and 0.170, respectively). Multivariate analyses showed that intraoperative systemic chemotherapy was a favorable prognostic factor for the overall survival and disease-free survival rates (P = 0.048 and 0.023, respectively). No grade 4 toxicities related to intraoperative systemic chemotherapy were recorded within 4 weeks after surgery. Conclusions: Intraoperative systemic chemotherapy during curative surgery may benefit patients with stage pTNM IB-IIIB gastric cancer in terms of both overall survival and disease-free survival.