Survival outcomes and patterns of failure after D2 dissection and adjuvant chemoradiotherapy for locally advanced gastric cancer: a retrospective study
Survival outcomes and patterns of failure after D2 dissection and adjuvant chemoradiotherapy for locally advanced gastric cancer: a retrospective study
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局部晚期胃癌 D2 切除和辅助放化疗后的生存结果和失败模式：一项回顾性研究
DOI：
10.1259/bjr.20170594
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发表时间：
2018-01-01
影响因子：
2.6
通讯作者：
Zhang, Zhen
中科院分区：
文献类型：
--
作者：
Yang, Wang;Hu, Ran;Zhang, Zhen
目的：本研究的目的是分析胃癌患者接受D2切除术和辅助放化疗（CRT）的失败发生率和模式。方法：2004年1月至2015年10月，324例胃癌患者接受根治性D2切除术后接受CRT。临床病理特征和失败的模式进行了回顾性分析，以确定与生存和复发的相关因素。结果：经过中位随访30个月，这些患者的3年总生存率和3年无病生存率分别为60.3%和51.1%。复发或转移117例，以腹膜复发最多（20.7%），其次为远处转移（14.2%）。最常累及的远端器官是肝脏（5.9%）和骨骼（4.9%）。39例患者（12.0%）发生局部失败，仅23例（7.1%）发生孤立性区域失败。进一步的多变量考克斯回归分析显示N分期是无远处转移生存的独立危险因素（p = 0.012）。腹膜转移的独立危险因素是肿瘤分化（p = 0.022）、T分期（p =0.035）和血管侵犯（p = 0.016）。结论：术后CRT对优化局部控制具有潜在作用，导致局部失败率仅为12.0%。在D2切除和辅助CRT后的患者中，腹膜转移是失败的主要模式，其次是远处转移。腹膜复发是D2剥离和辅助CRT后最常见的失败模式，其次是远处转移，而局部复发相对罕见，根据每种复发模式的预测风险选择患者可能是优化治疗策略的合理方法。
Objective: The goal of the study was to analyze the incidence and patterns of failure in patients with gastric cancer who received D2 dissection and adjuvant chemoradiotherapy (CRT).Methods: From January 2004 to October 2015, 324 patients with gastric cancer who underwent radical D2 resection followed by postoperative CRT were enrolled. Clinicopathological characteristics and patterns of failure were retrospectively reviewed to identify factors associated with survival and recurrence.Results: After a median follow-up of 30 months, the 3-year overall survival and 3-year disease-free survival rates of these patients were 60.3 and 51.1%, respectively. 117 patients had recurrence or metastasis, with peritoneal recurrence as the most frequent (20.7%), followed by distant metastasis (14.2%). The most commonly involved distant organs were the liver (5.9%) and bone (4.9%). Locoregional failure occurred in 39 patients (12.0%), with isolated regional failure occurring in only 23 (7.1%). Further multivariate Cox regression analysis revealed N stage to be an independent risk factor for distant failure-free survival (p = 0.012). Independent risk factors for peritoneal metastasis were tumor differentiation (p = 0.022), T stage (p =0.035) and vascular invasion (p = 0.016).Conclusion: Postoperative CRT has a potential effect on optimizing locoregional control, resulting in only 12.0% of locoregional failure. In patients after D2 resection and adjuvant CRT, peritoneal metastasis was the leading pattern of failure, followed by distant metastasis.Advances in knowledge: Peritoneal recurrence was the most common pattern of failure after D2 dissection and adjuvant CRT, followed by distant metastasis, whereas locoregional relapse was relatively rare, Selection of patients based on the predicted risk of each recurrence pattern may be a reasonable approach to the optimization of treatment strategies.