Stage-specific effect of adjuvant therapy following gastric cancer resection: a population-based analysis of 4,041 patients
Stage-specific effect of adjuvant therapy following gastric cancer resection: a population-based analysis of 4,041 patients
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DOI：
10.1245/s10434-007-9640-0
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发表时间：
2008-02-01
影响因子：
3.7
通讯作者：
Baxter, Nancy N.
中科院分区：
文献类型：
--
作者：
Coburn, Natalie G.;Govindarajan, Anand;Baxter, Nancy N.
背景资料：在西南肿瘤组/Intergroup 0116试验中，辅助放化疗改善了切除胃腺癌患者的生存率。我们的目的是研究辅助治疗对总生存期（OS）在一般population.Methods的影响：患者18-85岁谁经历了切除非转移性胃腺癌2000年5月至2003年12月，从监测流行病学和最终结果（SEER）数据库。排除了接受过术前放疗、分期或放疗状态未知或自诊断之日起生存期≤ 3个月的患者。采用Kaplan-Meier方法和考克斯比例风险模型比较接受术后放疗和未接受术后放疗患者的生存率。在4，041例患者中，III期和IVM 0期接受辅助放疗的患者生存率提高，中位OS为31个月，而不是24个月在单因素分析中，II期患者的生存率有提高的趋势（P = 0.0535）。在最终校正分析中，辅助放疗显著改善了III期（HR：0.71，P = 0.0007）和IVM 0期（HR：0.66，P < 0.0001）的OS。使用倾向评分进行的校正分析表明，辅助放疗的益处在II期和III期患者中相似。然而，有没有统计学改善生存期Ib和II期患者接受了辅助radiation.Conclusions：在这个以人群为基础的分析，辅助放射治疗III期和IVM 0胃癌显着改善OS。分析阶段Ib和II期患者是有限的小数目，但可能不会有相同的好处。
Background: Adjuvant chemoradiotherapy improved survival in patients with resected gastric adenocarcinoma in the Southwest Oncology Group/Intergroup 0116 trial. Our objective was to examine the impact of adjuvant treatment on overall survival (OS) in the general population.Methods: Patients 18-85 years old who had undergone resection of non-metastatic gastric adenocarcinoma between May 2000 and December 2003, were identified from the Surveillance Epidemiology and End Results (SEER) database. Patients who had received pre-operative irradiation, had unknown stage or radiation status, or had a survival of 3 months or less from the date of diagnosis were excluded. Survival of those who received post-operative irradiation was compared with those who did not; Kaplan-Meier methods and Cox proportional hazards models were used.Results: Of 4,041 patients, there was improved survival for those receiving adjuvant irradiation for stages III and IVM0, with a median OS of 31 versus 24 months (P = 0.005) and 20 versus 15 months (P < 0.001), respectively, and a trend for improved survival in univariate analysis of stage II (P = 0.0535). In final adjusted analysis, adjuvant irradiation significantly improved OS in stages III (HR: 0.71, P = 0.0007) and IVM0 (HR: 0.66, P < 0.0001). Adjusted analysis using a propensity score suggested that the benefit of adjuvant irradiation was similar in stage-II and -III patients. However, there was no statistical improvement in survival for stage-Ib and -II patients who had received adjuvant irradiation.Conclusions: In this population-based analysis, adjuvant radiotherapy for stage-III and IVM0 gastric cancer significantly improved OS. Analysis of stage-Ib and -II patients is limited by small numbers, but there may not be the same benefit.