Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer?
Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer?
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DOI：
10.1245/s10434-007-9574-6
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发表时间：
2007-12-01
影响因子：
3.7
通讯作者：
Coit, Daniel G.
中科院分区：
文献类型：
--
作者：
Mansour, John C.;Tang, Laura;Coit, Daniel G.
背景资料：MAGIC试验结果发表后，术前化疗越来越多地用于切除前治疗晚期胃癌。测量响应的工具，必须assessed.Methods：我们确定了所有的胃癌患者与新辅助化疗和R 0切除术治疗1991年至2005年之间的前瞻性数据库。排除术前接受放疗的患者。由一名病理学家对治疗的组织学反应进行分级，从0%至100%。进行Kaplan-Meier生存分析，以确定缓解和结局之间的关系，并确定疾病特异性生存（DSS）的预测因素。进行多变量分析，以确定独立predictors.Results：共168例患者接受新辅助化疗后进行R 0切除。33%的肿瘤位于胃食管交界处。68%的患者使用了以顺铂为基础的治疗。22%的患者对治疗的病理反应> 50%。所有患者切除后的中位随访时间为25个月。所有患者的中位DSS为33个月。3年DSS从44%改善至69%，组织学缓解率至少为50%（P = 0.01）。与DSS降低相关的因素包括切除时的阳性淋巴结、pT 3或更大的肿瘤、高级别、神经周围或血管浸润以及< 50%的反应。多变量分析确定了淋巴结状态和神经或血管浸润作为生存的独立预测因子。结论：治疗后淋巴结状态和神经或血管浸润切除术，但不分级组织学反应，独立预测DSS后新辅助化疗和手术切除胃癌。
Background: After publication of the MAGIC trial results, preoperative chemotherapy is increasingly used to treat advanced gastric cancer before resection. Tools for measuring response must be assessed.Methods: We identified all patients with gastric cancer treated with neoadjuvant chemotherapy and R0 resection between 1991 and 2005 from a prospective database. Patients receiving preoperative radiation were excluded. Histologic response to treatment was graded from 0% to 100% by a single pathologist. Kaplan-Meier survival analysis was performed to identify the relationship between response and outcome and to identify factors predictive of disease-specific survival (DSS). Multivariate analysis was performed to identify independent predictors.Results: A total of 168 patients underwent R0 resection after receiving neoadjuvant chemotherapy. Thirty-three percent of tumors were at the gastroesophageal junction. Cisplatin-based therapy was used for 68% of patients. Twenty-two percent of patients had a > 50% pathologic response to treatment. Median follow-up after resection for all patients was 25 months. Median DSS for all patients was 33 months. Three-year DSS improved from 44% to 69% with at least a 50% histologic response (P = .01). Factors associated with decreased DSS included positive nodes at resection, pT3 tumor or greater, high grade, perineural or vascular invasion, and < 50% response. Multivariate analysis identified nodal status and perineural or vascular invasion as independent predictors of survival.Conclusions: Posttreatment nodal status and perineural or vascular invasion at resection, but not graded histologic response, independently predict DSS after neoadjuvant chemotherapy and surgical resection of gastric cancer.