新辅助化疗对联合脏器切除胃癌根治术安全性及预后的影响  

Influence of neoadjuvant chemotherapy on safety and prognosis of patients undergoing multivisceral resection for gastric cancer

作　　者：胡博扬 张钰 臧明德 黄华[1] Hu Boyang;Zhang Yu;Zang Mingde;Huang Hua(Department of Gastric Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院胃外科、复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中华消化外科杂志》2023年第12期1449-1455,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81902392,82273181);上海申康医院发展中心临床三年行动计划(SHDC2020CR3033B)。

摘　　要：目的探讨新辅助化疗对联合脏器切除胃癌根治术安全性及预后的影响。方法采用倾向评分匹配及回顾性队列研究方法。收集2011年12月至2020年12月复旦大学附属肿瘤医院收治的144例行联合脏器切除胃癌根治术患者的临床病理资料;男95例,女49例;年龄为(56±13)岁。144例患者中,27例行新辅助化疗和术后辅助化疗,设为新辅助化疗组;117例行术后辅助化疗,设为辅助化疗组。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较。(2)手术及术后情况。(3)预后情况。倾向评分匹配按1∶1最近邻匹配法匹配,卡钳值设定为0.02。正态分布的计量资料以x±s表示;偏态分布的计量资料以M(范围)表示,组间比较采用秩和检验。计数资料以绝对数表示,组间比较采用χ^(2)检验。等级资料比较采用非参数检验。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-Rank检验进行生存分析。结果(1)倾向评分匹配情况及匹配后两组患者一般资料比较。144例患者中,46例配对成功,新辅助化疗组和辅助化疗组各23例。倾向评分匹配后消除术前血红蛋白、临床TNM分期因素混杂偏倚,具有可比性。(2)手术及术后情况。46例患者中,26例行胃联合1个脏器切除术,16例行胃联合2个脏器切除术,4例行胃联合3个脏器切除术;联合脏器切除中,联合脾脏切除、胰体尾切除、结肠切除、肝切除、小肠切除比例分别为69.6%(32/46)、39.1%(18/46)、32.6%(15/46)、8.7%(4/46)、2.2%(1/46)。新辅助化疗组和辅助化疗组患者行D1淋巴结清扫、D2淋巴结清扫,R0切除、R1切除分别为1、22例,23、0例和0、23例,23、0例,两组比较,差异均无统计学意义(P>0.05);淋巴结清扫数目、术中出血量、术后住院时间分别28(22~37)枚、150(100~200)mL、11(8~16)d和25(18~32)枚、150(100~200)mL、11(9~18)d,两组比较,差异均无统计学意义(Z=-1.13,-0.32,-0.50,P>0.05)。新辅助化疗组患者Objective To investigate the influence of neoadjuvant chemotherapy on safety and prognosis of patients undergoing multivisceral resection for gastric cancer.Methods The propensity score matching(PSM)and retrospective cohort study was conducted.The clinicopathological data of 144 patients with gastric cancer who underwent multivisceral resection in the Fudan University Shanghai Cancer Center from December 2011 to December 2020 were collected.There were 95 males and 49 females,aged(56±13)years.Of 144 patients,27 cases undergoing neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were divided into the neoadjuvant chemotherapy group,and 117 cases undergoing postoperative adjuvant chemotherapy were divided into the adjuvant chemotherapy group.Observation indicators:(1)PSM and comparison of general data of patients between the two groups after matching;(2)surgical and postoperative conditions;(3)prognosis.PSM was done by the 1∶1 nearest neighbor matching method,with the caliper setting as 0.02.Measurement data with normal distribution were expressed as Mean±SD.Measurement data with skewed distribution were expressed as M(range),and comparison between groups was conducted using the rank sum test.Count data were expressed as absolute numbers,comparison between groups was conducted using the chi-square test.Comparison of ordinal data was conducted using the nonparameter test.The Kaplan-Meier method was used to draw survival curves and calculate survival rate,and the Log-Rank test was used for survival analysis.Results(1)PSM and comparison of general data of patients between the two groups after matching.Of 144 patients,46 cases were successfully matched,including 23 cases in the neoadjuvant chemotherapy group and 23 cases in the adjuvant chemotherapy group,respectively.The elimination of preoperative hemoglobin,clinical TNM staging confounding bias ensured comparability between the two groups after PSM.(2)Surgical and postoperative conditions.Of 46 patients,26 cases underwent gastrectomy with one organ r

关 键 词：胃肿瘤 胃癌根治术 新辅助化疗 辅助化疗 联合脏器切除 

分 类 号：R735.2[医药卫生—肿瘤]