Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center.
Adjuvant chemoradiotherapy after d2-lymphadenectomy for gastric cancer: the role of n-ratio in patient selection. results of a single cancer center.
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DOI：
10.1186/1748-717x-7-169
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发表时间：
2012-10-15
期刊：
影响因子：
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通讯作者：
Montagnini AL
中科院分区：
文献类型：
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作者：
Costa WL Jr;Coimbra FJ;Fogaroli RC;Ribeiro HS;Diniz AL;Begnami MD;Mello CA;Fanelli MF;Silva MJ;Fregnani JH;Montagnini AL
辅助放化疗是提高胃癌术后生存率的多模式治疗方法的一部分。本研究的目的是描述在单一机构接受胃切除术和辅助放化疗的患者的结果，并确定可以决定哪些个体将从这种治疗中受益的预后因素。这项回顾性研究纳入了1998年至2008年间在巴西单一癌症中心接受手术治疗的病理证实的胃腺癌患者。在此期间治疗的327例患者中，选择142例。排除标准为远处转移性疾病（M1）、T1N0肿瘤、不同的多模式治疗和残肢肿瘤。另有10例患者失访，术后死亡3例。确定了几个临床和病理变量作为预后因素的作用。90.8%的患者行了d2淋巴结切除术，5年总生存率为58.9%，无病生存率为55.7%。n类别和n比率的相互作用，扩大切除和神经周围浸润是总生存和无病生存的独立预后因素。辅助放化疗与生存率的显著改善无关。淋巴结阳性患者接受辅助放化疗后生存率提高，特别是当我们将N1和N2肿瘤患者分组时，n比更高。这些个体的无病（30.3%对48.9%）和总生存率（30.9%对71.4%）较差。n -分类和n -比值相互作用、神经周围浸润和扩大切除是影响胃癌d2 -淋巴结切除术患者生存的预后因素，但辅助放化疗不是。对于淋巴结阳性且n比较高的患者，这种治疗可能会有一些益处。
Adjuvant chemoradiotherapy is part of a multimodality treatment approach in order to improve survival outcomes after surgery for gastric cancer. The aims of this study are to describe the results of gastrectomy and adjuvant chemoradiotherapy in patients treated in a single institution, and to identify prognostic factors that could determine which individuals would benefit from this treatment. This retrospective study included patients with pathologically confirmed gastric adenocarcinoma who underwent surgical treatment with curative intent in a single cancer center in Brazil, between 1998 and 2008. Among 327 patients treated in this period, 142 were selected. Exclusion criteria were distant metastatic disease (M1), T1N0 tumors, different multimodality treatments and tumors of the gastric stump. Another 10 individuals were lost to follow-up and there were 3 postoperative deaths. The role of several clinical and pathological variables as prognostic factors was determined. D2-lymphadenectomy was performed in 90.8% of the patients, who had 5-year overall and disease-free survival of 58.9% and 55.7%. The interaction of N-category and N-ratio, extended resection and perineural invasion were independent prognostic factors for overall and disease-free survival. Adjuvant chemoradiotherapy was not associated with a significant improvement in survival. Patients with node-positive disease had improved survival with adjuvant chemoradiotherapy, especially when we grouped patients with N1 and N2 tumors and a higher N-ratio. These individuals had worse disease-free (30.3% vs. 48.9%) and overall survival (30.9% vs. 71.4%). N-category and N-ratio interaction, perineural invasion and extended resections were prognostic factors for survival in gastric cancer patients treated with D2-lymphadenectomy, but adjuvant chemoradiotherapy was not. There may be some benefit with this treatment in patients with node-positive disease and higher N-ratio.