Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis
Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis
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DOI：
10.1007/s00432-021-03516-7
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发表时间：
2021-02-03
影响因子：
3.6
通讯作者：
Kato, Junji
中科院分区：
文献类型：
--
作者：
Ohnuma, Hiroyuki;Sato, Yasushi;Kato, Junji
不能切除的胃癌（GC）的转换手术（CS）的临床效益，即不能切除的GC对化疗有反应，随后接受治疗性手术，目前尚不清楚。在这里，我们的目的是澄清CS的临床价值。方法在这项回顾性队列研究中，我们分析了2004年至2019年期间接受三联联合化疗的175例不可切除的GC。我们将患者分为两组：接受CS的患者和仅接受化疗的患者（分别为CS组和C组）。倾向评分匹配用于最小化混杂偏倚。结果175例中61例（34.9%）行CS。R 0切除率为85.2%。匹配后，选择了44对;基线协变量无显著差异。CS组的中位总生存期（OS）显著更好（18.8 vs. 46.0个月，p < 0.001），无进展生存期延长（7.4 vs. 25.8个月，p < 0.001）。OS的亚组分析显示，几乎所有亚组的CS均呈有利趋势。多因素分析显示，良好的ECOG体力状态和CS与较长的OS相关。结论CS的生存益处在单因素和多因素分析中一致，即使在匹配的队列中。需要进行更多的大规模试验以进一步验证。
Purpose The clinical benefit of conversion surgery (CS) for unresectable gastric cancer (GC), whereby unresectable GC responds to chemotherapy and subsequently receives curative-intent surgery, remains unclear. Here, we aimed to clarify the clinical value of CS. Methods In this retrospective cohort study, we analyzed 175 unresectable GC, who received triple combined chemotherapy between 2004 and 2019. We divided patients into two groups: those who underwent CS and those receiving chemotherapy only (CS and C groups, respectively). Propensity score matching was used to minimize confounding bias. Results Of 175 cases, 61 (34.9%) underwent CS. R0 resection was obtained in 85.2%. After matching, 44 pairs were selected; there were no significant differences in baseline covariants. Group CS had a significantly better median overall survival (OS) (18.8 vs. 46.0 months, p < 0.001), and prolonged progression-free survival (7.4 vs. 25.8 months, p < 0.001). Subgroup analysis of OS showed a favorable trend for CS for almost all subgroups. Multivariate analysis revealed that good ECOG performance status and CS were associated with a longer OS. Conclusion The survival benefit of CS was consistently demonstrated in the univariate and multivariate analysis, even in the matched cohort. Additional large-scale trials are needed for further validation.