Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study
Neoadjuvant chemotherapy vs upfront surgery for gastric signet ring cell carcinoma: A retrospective, propensity score-matched study
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胃印戒细胞癌的新辅助化疗前期手术：一项回顾性倾向评分匹配研究
DOI：
10.3748/wjg.v26.i8.818
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发表时间：
2020-02-28
影响因子：
4.3
通讯作者：
Tian, Yan-Tao
中科院分区：
文献类型：
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作者：
Li, Yang;Ma, Fu-Hai;Tian, Yan-Tao
背景新辅助化疗对胃印戒细胞癌患者的获益存在争议。目的评估局部晚期胃印戒细胞癌新辅助化疗的围手术期和远期结局。方法本回顾性研究采用临床肿瘤-淋巴结-转移指标，筛选2012年1月至2017年12月诊断的局部晚期胃印戒细胞癌（cT3/4和cNany）患者。 （cTNM）分期系统。我们进行了 1:1 倾向评分匹配 (PSM)，以减少患者选择中的偏差。评估新辅助化疗的组织学和预后效果。以总生存率作为结果指标，比较新辅助化疗与先行手术治疗在所选患者中的疗效。 结果在符合本研究资格的 144 名患者中，36 名患者接受了新辅助化疗，108 名患者在诊断后接受了初次手术。经过 PSM 调整后，生成了 36 对患者，两组患者的基线特征（包括年龄、性别、美国麻醉医师协会评分、肿瘤位置和 cTNM 分期）相似。 PSM后先手术组和新辅助化疗组的R0切除率分别为88.9%和86.1%（P = 1.000）。中位随访时间为 46.4 个月。 PSM前新辅助化疗组和先手术组5年总生存率分别为50.0%和65.0%（P=0.235），PSM后分别为50%和64.7%（P=0.192）。 PSM 前后进行的多变量分析表明 NAC 不是预后因素。 结论 新辅助化疗对局部晚期胃印戒细胞癌患者没有带来生存获益。对于可切除的胃印戒细胞癌，前期手术应是主要治疗方法。
BACKGROUNDThe benefit of neoadjuvant chemotherapy for patients with signet-ring cell carcinoma of the stomach is controversial.AIMTo evaluate the perioperative and long-term outcomes of neoadjuvant chemotherapy for locally advanced gastric signet-ring cell carcinoma.METHODSThis retrospective study identified patients with locally advanced signet-ring cell carcinomas of the stomach (cT3/4 and cN any) diagnosed from January 2012 to December 2017 by using the clinical Tumor-Node-Metastasis (cTNM) staging system. We performed 1:1 propensity score matching (PSM) to reduce bias in patient selection. The histologic and prognostic effects of neoadjuvant chemotherapy were assessed. The overall survival rates were used as the outcome measure to compare the efficacy of neoadjuvant chemotherapy vs surgery-first treatment in the selected patients.RESULTSOf the 144 patients eligible for this study, 36 received neoadjuvant chemotherapy, and 108 received initial surgery after diagnosis. After adjustment by PSM, 36 pairs of patients were generated, and baseline characteristics, including age, sex, American Society of Anesthesiologists score, tumor location, and cTNM stage, were similar between the two groups. The R0 resection rates were 88.9% and 86.1% in the surgery-first and neoadjuvant chemotherapy groups after PSM, respectively (P = 1.000). The median follow-up period was 46.4 mo. The 5-year overall survival rates of the neoadjuvant chemotherapy group and surgery-first group were 50.0% and 65.0% (P = 0.235), respectively, before PSM and 50% and 64.7% (P = 0.192), respectively, after PSM. Multivariate analyses conducted before and after PSM showed that NAC was not a prognostic factor.CONCLUSIONNeoadjuvant chemotherapy provides no survival benefit in patients with locally advanced gastric signet-ring cell carcinoma. For resectable gastric signet-ring cell carcinoma, upfront surgery should be the primary therapy.