Clinical significance of adjuvant surgery following chemotherapy for patients with initially unresectable stage IV gastric cancer.
Clinical significance of adjuvant surgery following chemotherapy for patients with initially unresectable stage IV gastric cancer.
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DOI：
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发表时间：
2015
影响因子：
2
通讯作者：
Shuhei Ito;E. Oki;Y. Nakashima;K. Ando;Y. Hiyoshi;K. Ohgaki;H. Saeki;M. Morita;Y. Sakaguchi;Y. Maehara
中科院分区：
文献类型：
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作者：
Shuhei Ito;E. Oki;Y. Nakashima;K. Ando;Y. Hiyoshi;K. Ohgaki;H. Saeki;M. Morita;Y. Sakaguchi;Y. Maehara
背景：对于不能切除的胃癌患者，需要更有效的治疗来改善其不良预后。我们探讨化疗后辅助手术的有效性和可行性。患者与方法回顾性分析70例不可切除的IV期胃癌患者行诱导化疗的临床资料。化疗期间出现无疗效临床因素的患者行胃切除术[辅助手术（AS）组]；其余继续化疗（非as组）。结果非AS组56例（80%），AS组14例（20%）。AS组92.9%的患者存在一种临床不治愈因素，而非AS组48.2%的患者存在两种及以上临床不治愈因素（p=0.0386）。AS组的手术结果，包括术后并发症发生率（21.4%），是可以接受的。AS组3年总生存率为65.6%，非AS组为7.7% （p<0.0001）。在存在腹膜播散这一非治愈临床因素的患者中，AS组的中位生存期为29.5个月，而非AS组为11.4个月（p=0.0230）。结论对初期不可切除的IV期胃癌进行辅助手术治疗是安全可行的，并可改善有腹膜播散等临床不可治愈因素的患者的预后。
BACKGROUND More effective treatment is necessary to improve the poor prognosis for patients with unresectable gastric cancer. We investigated the efficacy and feasibility of adjuvant surgery following chemotherapy. PATIENTS AND METHODS Records of 70 patients with unresectable stage IV gastric cancer who underwent induction chemotherapy were reviewed retrospectively. Patients who developed an absence of non-curative clinical factors during chemotherapy underwent gastrectomy [adjuvant surgery (AS) group]; the others continued chemotherapy [non-AS group]. RESULTS Non-AS and AS groups contained 56 (80%) and 14 (20%) patients, respectively. In the AS group, 92.9% of patients had one non-curative clinical factor, while 48.2% of patients in the non-AS group had two or more non-curative clinical factors (p=0.0386). In the AS group, operative outcomes, including the postoperative complication rate (21.4%), were acceptable. The 3-year overall survival rate in the AS group was 65.6% versus 7.7% in the non-AS group (p<0.0001). In patients with one non-curative clinical factor of peritoneal dissemination, the median survival of the AS group was 29.5 months versus 11.4 months in the non-AS group (p=0.0230). CONCLUSION Adjuvant surgery for initially unresectable stage IV gastric cancer was safe and feasible, and may improve the prognosis for patients with one non-curative clinical factor, such as peritoneal dissemination.