Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas
Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas
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DOI：
10.1245/s10434-018-6541-3
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发表时间：
2018-08-01
影响因子：
3.7
通讯作者：
Schmidt, Thomas
中科院分区：
文献类型：
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作者：
Heger, Ulrike;Sisic, Leila;Schmidt, Thomas
只有少数研究分析了印戒细胞含上胃肠道（GI）癌亚组的多模式治疗概念。最近的回顾性多中心数据支持对胃印戒细胞癌（SRCs）进行首次切除而不进行新辅助化疗。我们比较了主要切除的癌与新辅助治疗的局部晚期食管胃src的结果。本研究共纳入来自前瞻性单中心数据库的310例食管胃src分期cT3/4/Nany/Many患者；NEO组192例（61.9%）接受新辅助治疗，RES组118例（38.1%）接受手术切除。总体而言，128例（41.3%）患者表现为食管胃交界处腺癌（AEG）， 182例（58.7%）患者表现为胃癌。新辅助治疗与治疗意图切除（NEO: 91.1%; RES: 75.4%; P = 0.001）、改善(y)pT类别（P = 0.035）、改善(y)pN类别（P < 0.001）和R0切除（治疗意图队列：NEO: 76.0% vs RES: 60.7%; P = 0.010）等显著相关，但与术后并发症无关。新辅助治疗显著提高了总生存期{中位生存期28.5个月（95%可信区间[CI] 14.4-39.6） vs RES: 14.9个月（10.6-17.5）；P < 0.001}，以及亚组（AEG和胃肿瘤，r0切除患者，有或没有相关合并症的患者）。独立预后因素为新辅助治疗（风险比[HR] 0.66, P = 0.023）、pT4分类（风险比[HR] 1.71, P = 0.041）、pN2分类（风险比[HR] 1.86, P = 0.013）、pN3分类（风险比[HR] 2.40, P < 0.001）、pM1分类（风险比[HR] 1.95, P = 0.003）、年龄（风险比[HR] 1.79, P = 0.006）、胃定位（风险比[HR] 0.69, P = 0.032）、美国麻醉医师学会分类3/4（风险比[HR] 1.71, P = 0.004）、不完全切除R1/2（风险比[HR] 1.6, P = 0.014）。我们的研究结果表明，新辅助治疗对晚期食管胃SRC患者有生存优势。
Only a few studies have analyzed multimodal treatment concepts in the subgroup of signet-ring-cell containing upper gastrointestinal (GI) cancer. Recent retrospective, multicentric data favor primary resection without neoadjuvant chemotherapy for gastric signet-ring-cell containing carcinomas (SRCs). We compared the outcomes of primarily resected carcinomas with neoadjuvantly treated, locally advanced esophagogastric SRCs.A total of 310 patients with esophagogastric SRC-staged cT3/4/Nany/Many from a prospective unicentric database were included in this study; 192 (61.9%) received neoadjuvant therapy (NEO group) and 118 (38.1%) were primarily resected (RES group).Overall, 128 (41.3%) patients presented with adenocarcinoma of the esophagogastric junction (AEG) and 182 (58.7%) presented with gastric cancer. Neoadjuvant therapy was significantly associated with resection in curative intent (NEO: 91.1%; RES: 75.4%; P = 0.001), improved (y)pT category (P = 0.035), improved (y)pN category (P < 0.001), and R0 resections (curative intent cohort: 76.0% in NEO vs. 60.7% in RES; P = 0.010), among others, but not with postoperative complications. Overall survival was significantly improved by neoadjuvant treatment {median survival 28.5 months (95% confidence interval [CI] 14.4-39.6) vs. RES: 14.9 months (10.6-17.5); P < 0.001}, as well as in subgroups (AEG and gastric tumors, R0-resected patients, and patients with and without relevant comorbidities). Independent prognostic factors were neoadjuvant therapy (hazard ratio [HR] 0.66; P = 0.023), pT4 category (HR 1.71; P = 0.041), pN2 category (HR 1.86; P = 0.013), pN3 category (HR 2.40; P < 0.001), pM1 category (HR 1.95; P = 0.003), age > 70 years (HR 1.79; P = 0.006), gastric localization (HR 0.69; P = 0.032), American Society of Anesthesiologists classification 3/4 (HR 1.71; P = 0.004), and incomplete resection R1/2 (HR 1.6; P = 0.014).Our results demonstrate a survival advantage for advanced-stage esophagogastric SRC patients by neoadjuvant treatment.