Adenocarcinomas of the Esophagogastric Junction Are More Likely to Respond to Preoperative Chemotherapy than Distal Gastric Cancer
Adenocarcinomas of the Esophagogastric Junction Are More Likely to Respond to Preoperative Chemotherapy than Distal Gastric Cancer
复制标题
DOI：
10.1245/s10434-011-2147-8
复制
发表时间：
2012-07-01
影响因子：
3.7
通讯作者：
Schumacher, Christoph
中科院分区：
文献类型：
--
作者：
Reim, Daniel;Gertler, Ralf;Schumacher, Christoph
术前化疗已被证明可以改善食管胃交界处腺癌（AEG）和胃癌（GC）患者的预后，组织病理学缓解已被确定为这些患者的独立预后参数。最近的一项荟萃分析表明，AEG患者比GC患者从术前化疗中获益更多。这项回顾性分析的目的是证明这些发现在一个经验丰富的单中心大的患者队列，因为目前没有招募前瞻性临床试验，在一个单一的center，551例患者接受术前铂类为基础的化疗，其次是肿瘤手术治疗局部晚期AEG和GC。治疗前的临床指标与术前化疗的组织病理学反应相关，130例（24%）患者的组织病理学反应（残留肿瘤< 10%）与总生存率显著相关（P < 0.0001）。肿瘤位于食管胃交界处（GE交界处）、基线cT分期较低和基线cN 0分期与组织病理学缓解显著相关（分别为P = 0.034、P = 0.015和P = 0.002）。在亚组分析中，后两个预测参数仅对AEG（n = 378）进行了确认，但对其他GC（n = 173）未进行确认。治疗前分期为cT 3/4、cN 0的AEG患者（n = 73）被确定为组织病理学反应率最高的亚组（48%）AEG比GC更可能对术前化疗有反应，这一发现可能有助于确定哪些患者将从术前化疗中获益。
Preoperative chemotherapy has been shown to improve outcome of patients with adenocarcinoma of the esophagogastric junction (AEG) and gastric cancer (GC), and histopathologic response has been identified as an independent prognostic parameter in these patients. A recent meta-analysis has identified patients with AEG as benefiting more from preoperative chemotherapy than patients with GC. The aim of this retrospective analysis was to prove these findings in an experienced single-center large patient cohort because there are currently no recruiting prospective clinical trials.In a single center, 551 patients underwent preoperative platin-based chemotherapy followed by oncologic surgery for locally advanced AEG and GC. Pretherapeutic clinical parameters were correlated with histopathologic response to preoperative chemotherapy.Histopathologic response (< 10% of residual tumor) was found in 130 patients (24%) and was significantly correlated with overall survival (P < 0.0001). Tumor localization at the esophagogastric junction (GE junction), lower baseline cT stage, and baseline cN0 stage were significantly associated with histopathologic response (P = 0.034, P = 0.015, and P = 0.002, respectively). In subgroup analyses, the latter two predictive parameters were confirmed only for AEG (n = 378) but not for other GC (n = 173). AEG patients who were pretherapeutically staged as having cT3/4, cN0 disease (n = 73) were identified as the subgroup with the highest rate of histopathologic response (48%).AEG is more likely to respond to preoperative chemotherapy than GC, a finding that might help identify patients who would benefit from preoperative chemotherapy.