Lymph node response to neoadjuvant chemotherapy as an independent prognostic factor in gastric cancer.
Lymph node response to neoadjuvant chemotherapy as an independent prognostic factor in gastric cancer.
复制标题
DOI：
10.3892/ol.2022.13535
复制
发表时间：
2022-09
期刊：
影响因子：
2.9
通讯作者：
Y. Wada;M. Nishi;K. Yoshikawa;C. Takasu;T. Tokunaga;T. Nakao;H. Kashihara;T. Yoshimoto;M. Shimada
中科院分区：
文献类型：
--
作者：
Y. Wada;M. Nishi;K. Yoshikawa;C. Takasu;T. Tokunaga;T. Nakao;H. Kashihara;T. Yoshimoto;M. Shimada
以前的研究已经揭示了新辅助化疗(NAC)在临床III期胃癌(GC)手术后的有效性。由于肿瘤的管腔结构，原发肿瘤部位(PT)的肿瘤体积有时很难测量；因此，评估NAC对淋巴结(LN)的反应可能有助于更准确地预测生存结果。因此，本研究评估了LN对NAC的反应以预测GC患者的生存结果。这项研究涉及160名临床III期GC患者，他们接受了NAC(n=14)和前期手术(n=146)。评估PT和LN对NAC的反应，评估各种临床病理因素，并进行COX比例风险回归分析以确定生存结果。接受NAC和直接手术的患者的总生存期(OS)和无病生存期(DFS)差异无统计学意义(OS，P=0.71；DFS，P=0.50)。然而，尽管PT反应没有显著差异，但在DFS(PT，P=0.93；LN，P<；0.01)和OS(PT，P=0.84；LN，P<；0.01)方面，对NAC无反应的LN患者的预后明显差于LN有效患者(P=0.93；LN，P<；0.01)。此外，中性粒细胞/淋巴细胞比率越高，DFS越差[单变量：危险比(HR)=4.23，P=0.06；多变量：HR=6.45，P=0.04]。NAC对LN的有效率对复发的预测有显著意义(单变量，HR=7.79，95%可信区间=1.16~63.51，P=0.02；多变量，HR=7.44，P=0.01)。总体而言，目前的研究揭示了LN对NAC的反应对于预测GC患者的生存结果的临床重要性。这些发现突出了优化治疗策略以改善患者选择和管理的潜在临床影响。
Previous studies have revealed the usefulness of neoadjuvant chemotherapy (NAC) followed by surgery for clinical stage III gastric cancer (GC). The tumor volume at the primary tumor site (PT) is sometimes difficult to measure because of the luminal structure; therefore, evaluation of the lymph node (LN) response to NAC may help to more accurately predict survival outcomes. The present study therefore evaluated the LN response to NAC for prediction of survival outcomes in patients with GC. The study involved 160 patients with clinical stage III GC who underwent NAC (n=14) and upfront surgery (n=146). PT and LN responses to NAC were evaluated, various clinicopathological factors were evaluated and Cox proportional hazard regression analyses were performed to determine survival outcomes. Overall survival (OS) and disease-free survival (DFS) were not significantly different between patients who underwent NAC and those who underwent upfront surgery (OS, P=0.71; DFS, P=0.50). However, although there were no significant differences in PT responses, patients classified as LN non-responders to NAC had a significantly worse prognosis compared with patients classified as LN responders in terms of DFS (PT, P=0.93; LN, P<0.01) and OS (PT, P=0.84; LN, P<0.01). Moreover, a higher neutrophil-lymphocyte ratio tended to be associated with poor DFS [univariate: hazard ratio (HR)=4.23, P=0.06; multivariate: HR=6.45, P=0.04]. Finally, an LN response to NAC was significantly better for prediction of recurrence (univariate, HR=7.79, 95% confidence interval=1.16-63.51, P=0.02; multivariate, HR=7.44, P=0.01). Overall, the current study revealed the clinical importance of the LN response to NAC for predicting survival outcomes in patients with GC. These findings highlight the potential clinical impact of optimizing treatment strategies to improve the selection and management of patients.