新辅助治疗胃癌病理完全缓解的影响因素及预后分析  

Prognosis and Related Factors of Patients with Pathological CompleteResponse after Neoadjuvant Therapy for Gastric Cancer

作　　者：王童博 周红 张晓杰 孙崇源 郭春光 陈应泰 周爱萍 金晶 赵东兵 WANG Tongbo;ZHOU Hong;ZHANG Xiaojie;SUN Chongyuan;GUO Chunguang;CHEN Yingtai;ZHOU Aiping;JIN Jing;ZHAO Dongbing(Department of Pancreatic and Gastric Surgical Oncology,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,CAMS and PUMC,Beijing 100021,China;Department of Medical Oncology,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,CAMS and PUMC,Beijing 100021,China;Department of Radiation Oncology,National Cancer Center,National Clinical Research Center for Cancer/Cancer Hospital,CAMS and PUMC,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院,肿瘤医院胰胃外科,北京100021 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院,肿瘤医院肿瘤内科,北京100021 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院,北京协和医学院,肿瘤医院放疗科,北京100021

出　　处：《中国医学科学院学报》2021年第4期571-578,共8页Acta Academiae Medicinae Sinicae

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2017L01)。

摘　　要：目的探讨新辅助治疗后胃癌病理完全缓解(pCR)的相关影响因素并分析患者预后的影响因素。方法回顾性分析2008年1至12月新辅助治疗胃癌根治术490例患者的临床病理资料,对影响胃癌病理完全缓解及预后的风险因素进行单因素和多因素分析。结果纳入的490例患者中41例达到pCR,pCR率为8.3%(41/490)。新辅助放化疗组pCR率为16.0%,新辅助化疗组为6.4%。多因素分析显示新辅助放化疗(OR=4.401,95%CI=2.023~9.574,P<0.001)、术前治疗疗效为部分缓解(OR=40.492,95%CI=5.366~305.572,P<0.001)是新辅助治疗后pCR的独立预测因素。预后多因素分析显示,肿瘤呈低分化(HR=1.809,95%CI=1.104~2.964,P=0.019)、贲门-胃底-胃体部肿瘤(HR=2.025,95%CI=1.497~2.739,P<0.001)、术中清扫淋巴结≤15枚(HR=1.482,95%CI=1.059~2.073,P=0.022)、术后出现并发症(HR=1.625,95%CI=1.156~2.285,P=0.005)是新辅助治疗后行胃癌根治术患者预后的独立危险因素,而术后病理达到完全缓解(HR=0.153,95%CI=0.048~0.484,P=0.001)及术后接受辅助化疗(HR=0.589,95%CI=0.421~0.823,P<0.001)是患者预后的独立保护因素。结论新辅助治疗后获得pCR的局部进展期胃癌患者可以获得满意的远期生存,并且是患者预后的独立预测因素。相较于单纯化疗,术前放化疗可以显著提高局部进展期胃癌的pCR率。Objective To investigate the related factors of pathological complete response(pCR)of patients with gastric cancer treated by neoadjuvant therapy and resection,and to analyze the risk factors of prognosis.Methods The clinical and pathological data of 490 patients with gastric cancer who received neoadjuvant therapy followed by radical gastrectomy from January to December in 2008 were retrospectively analyzed.Univariate and multivariate analyses were performed to identify the risk factors affecting pCR and prognosis.Results Among the 490 patients,41 achieved pCR,and the overall pCR rate was 8.3%(41/490).The pCR rate was 16.0%in the neoadjuvant chemoradiation group and 6.4%in the neoadjuvant chemotherapy group.The results of multivariate analysis showed that neoadjuvant chemoradiation(OR=4.401,95%CI=2.023-9.574,P<0.001)and preoperative therapeutic response as partial response(OR=40.492,95%CI=5.366-305.572,P<0.001)were independent predictors of pCR after neoadjuvant therapy.Multivariate analysis of prognosis showed that poorly differentiated tumor(HR=1.809,95%CI=1.104-2.964,P=0.019),gastric cardia-fundus-body tumor(HR=2.025,95%CI=1.497-2.739,P<0.001),≤15 intraoperative dissected lymph nodes(HR=1.482,95%CI=1.059-2.073,P=0.022),and postoperative complications(HR=1.625,95%CI=1.156-2.285,P=0.005)were independent risk factors for prognosis,while pCR(HR=0.153,95%CI=0.048-0.484,P=0.001)and postoperative adjuvant chemotherapy(HR=0.589,95%CI=0.421-0.823,P<0.001)were independent protective factors of prognosis.Conclusions Patients who achieved pCR after neoadjuvant therapy for locally advanced gastric cancer might have promising long-term survival,and pCR is an independent predictor for overall survival.Compared with chemotherapy alone,preoperative chemoradiotherapy can significantly improve the pCR rate of patients with locally advanced gastric cancer.

关 键 词：局部进展期胃癌 新辅助治疗 病理完全缓解 胃癌根治术 预后 

分 类 号：R735.2[医药卫生—肿瘤]