Impact of the Extent of Surgery and Postoperative Chemoradiotherapy on Recurrence Patterns in Gastric Cancer
Impact of the Extent of Surgery and Postoperative Chemoradiotherapy on Recurrence Patterns in Gastric Cancer
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DOI：
10.1200/jco.2009.26.9654
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发表时间：
2010-05-10
影响因子：
45.3
通讯作者：
Verheij, Marcel
中科院分区：
文献类型：
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作者：
Dikken, Johan L.;Jansen, Edwin P. M.;Verheij, Marcel
目的Intergroup 0116 试验证明术后放化疗 (CRT) 可提高胃癌患者的生存率。我们回顾性比较了两项评估强化术后 CRT 的 I/II 期研究与荷兰胃癌组试验 (DGCT) 的生存和复发模式，该试验将患者随机分配到 D1 和 D2 淋巴结切除术之间。 患者和方法 91 例接受手术后放疗联合化疗的胃腺癌患者的生存和复发模式 对氟尿嘧啶和亚叶酸 (n = 5)、卡培他滨 (n = 39) 或卡培他滨和顺铂 (n = 47) 进行分析，并与来自 DGCT 的 694 名患者（D1，n = 369；D2，n = 325）的生存和复发模式进行比较。对于两组，均计算了 Maruyama 未切除疾病指数 (MI)，并将其与生存率和复发模式相关联。 结果 CRT 组的中位随访时间为 19 个月，仅手术 (DGCT) 组 2 年后的局部复发率显着较高 (17% vs 5%；P = .0015)。对接受 D1 解剖的 CRT 患者 (n = 39) 与 DGCT-D1 (n = 369) 的单独分析显示，放化疗后局部复发较少 (2% vs 8%；P = 0.001)，而 CRT-D2 (n = 25) 与 DGCT-D2 (n = 325) 的比较显示没有显着差异。 CRT 显着提高了显微镜下不根治性 (R1) 切除术后的生存率。 MI被发现是生存的一个强有力的独立预测因子。结论D1手术后，术后CRT的添加对可切除胃癌的局部复发有重大影响。
PurposeThe Intergroup 0116 trial has demonstrated that postoperative chemoradiotherapy (CRT) improves survival in gastric cancer. We retrospectively compared survival and recurrence patterns in two phase I/II studies evaluating more intensified postoperative CRT with those from the Dutch Gastric Cancer Group Trial (DGCT) that randomly assigned patients between D1 and D2 lymphadenectomy.Patients and MethodsSurvival and recurrence patterns of 91 patients with adenocarcinoma of the stomach who had received surgery followed by radiotherapy combined with fluorouracil and leucovorin (n = 5), capecitabine (n = 39), or capecitabine and cisplatin (n = 47) were analyzed and compared with survival and recurrence patterns of 694 patients from the DGCT (D1, n = 369; D2, n = 325). For both groups, the Maruyama Index of Unresected Disease (MI) was calculated and correlated with survival and recurrence patterns.ResultsWith a median follow-up of 19 months in the CRT group, local recurrence rate after 2 years was significantly higher in the surgery only (DGCT) group (17% v 5%; P = .0015). Separate analysis of CRT patients who underwent a D1 dissection (n = 39) versus DGCT-D1 (n = 369) showed fewer local recurrences after chemoradiotherapy (2% v 8%; P = .001), whereas comparison of CRT-D2 (n = 25) versus DGCT-D2 (n = 325) demonstrated no significant difference. CRT significantly improved survival after a microscopically irradical (R1) resection. The MI was found to be a strong independent predictor of survival.ConclusionAfter D1 surgery, the addition of postoperative CRT had a major impact on local recurrence in resectable gastric cancer.