Improving survival of stage II-III primary gastric signet ring cell carcinoma by adjuvant chemoradiotherapy.
Improving survival of stage II-III primary gastric signet ring cell carcinoma by adjuvant chemoradiotherapy.
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通过辅助放化疗提高 II-III 期原发性胃印戒细胞癌的生存率
DOI：
10.1002/cam4.3342
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发表时间：
2020-09
期刊：
影响因子：
4
通讯作者：
Tian Y
中科院分区：
文献类型：
--
作者：
Li Y;Zhu Z;Ma F;Xue L;Tian Y
对于胃印戒细胞癌（GSRC）的适当治疗策略以改善预后，目前尚无一致的证据。我们进行了一项基于人群的研究，使用监测、流行病学和最终结果（SEER）数据来检查综合疗法对生存结局的影响。分析包括2006年至2016年间诊断的II-III期原发性GSRC患者。治疗方法分为胃切除术组、辅助化疗（CT）组、新辅助放疗（RT）组和辅助放化疗（CRT）组。采用Kaplan-Meier法和考克斯比例风险模型进行生存分析，并按性别、肿瘤部位、诊断时分期和切除的淋巴结数量进行亚组。在1717例II-III期原发性GSRC病例中，平均（SD）年龄为59.6（13.3）岁，超过一半为男性（52.8%）。共有39.9%的患者接受了辅助CRT，5年总生存率（OS）为34.6%。接受辅助CRT治疗的患者的中位OS显著长于胃切除术组（33个月vs 24个月，aHR = 0.71，95% CI：0.59，0.84）。尽管粗模型显示辅助CT与总生存期之间存在显著相关性（cHR = 0.81，95% CI：0.68，0.96），但在多变量和亚组分析中，效应指标变为零。我们没有发现新辅助RT的显著效果。在这项研究中，II-III期GSRC患者在接受辅助CRT后的总生存率有所改善，这提供了几个治疗意义。需要更多的临床试验来验证本研究得出的结论。辅助CRT可提高原发性局部晚期GSRC患者的总生存率，而辅助CT和新辅助RT的效果不明显。
There is no consistent evidence about the appropriate treatment strategies for gastric signet ring cell carcinoma (GSRC) to improve prognosis. We conducted a population‐based study to examine the effects of combined modality therapies on survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) data. Analyses included stage II‐III primary GSRC patients who were diagnosed between 2006 and 2016. Therapies were categorized as gastrectomy group, adjuvant chemotherapy (CT) group, neoadjuvant radiotherapy (RT) group, and adjuvant chemoradiotherapy (CRT) group. Survival analyses were conducted by Kaplan‐Meier method and Cox proportional hazards models and subgrouped by gender, tumor site, stage at diagnosis, and number of lymph nodes removed. Of the 1717 cases of stage II‐III primary GSRC, the mean (SD) age was 59.6 (13.3) years, and over a half were male (52.8%). A total of 39.9% patients received adjuvant CRT and the 5‐year overall survival (OS) rate was 34.6%. The median OS of patients treated with adjuvant CRT was significantly longer than that of the gastrectomy group (33 months vs 24 months, aHR = 0.71, 95% CI: 0.59, 0.84). Although the crude model showed a significant association between adjuvant CT and total survival (cHR = 0.81, 95% CI: 0.68, 0.96), the effect measure turned null in the multivariable and sub‐group analysis. We did not find the significant effect of neoadjuvant RT. In this study, GSRC patients with stage II‐III experienced improved overall survival after receiving adjuvant CRT, which provides several treatment implications. More clinical trials will be needed to verify the conclusion derived from this study. The adjuvant CRT can improve overall survival of patients with primary locally advanced GSRC, and the effect of adjuvant CT and neoadjuvant RT was not found.
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