切缘肿瘤细胞残留对局部进展期胃癌复发模式和远期预后的影响  

Effect of residual marginal tumor cells on recurrence pattern and long-term prognosis of locally advanced gastric cancer

作　　者：李泽锋 郭春光 杜春霞 赵东兵 LI Zefeng;GUO Chunguang;DU Chunxia;ZHAO Dongbing(Department of Pancreatic and Gastric Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,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内科,北京100021

出　　处：《癌症进展》2024年第8期834-839,共6页Oncology Progress

基　　金：中国癌症基金会“北京希望马拉松”专项基金(LC2022L03);中国医学科学院医学与健康科技创新工程项目(2021-I2M-C&T-A-014)。

摘　　要：目的探究切缘肿瘤细胞残留(R1切除)局部进展期胃癌辅助化疗后的复发模式及远期预后。方法收集440例经D2根治性切除的局部进展期胃癌患者。比较R0切除(414例)和R1切除(26例)患者的临床特征、复发转移模式及预后。结果倾向性匹配前,R0切除和R1切除局部进展期胃癌患者N分期、脉管侵犯情况比较,差异均有统计学意义(P﹤0.05);倾向性匹配后,各临床特征比较,差异均无统计学意义(P﹥0.05)。R0切除和R1切除局部进展期胃癌患者复发模式比较,差异无统计学意义(P﹥0.05)。倾向性匹配前,R0切除和R1切除患者总生存情况和无复发生存情况比较,差异均有统计学意义(P﹤0.01)。倾向性匹配后,R0切除和R1切除患者总生存情况和无复发生存情况比较,差异均无统计学意义(P﹥0.05)。倾向性匹配后,不同化疗方案R1切除局部进展期胃癌患者的生存情况比较,差异无统计学意义(P﹥0.05)。结论R1切除局部进展期胃癌患者通常伴随着更晚的分期、更差的生物学行为和预后。R1切除胃癌患者术后辅助治疗应以局部治疗不影响全身系统性药物治疗为原则。Objective To investigate the recurrence pattern and long-term prognosis of locally advanced gastric cancer after adjuvant chemotherapy with residual marginal tumor cells(R1 resection).Method A total of 440 patients with locally advanced gastric cancer underwent D2 radical resection were collected.The clinical features,recurrence patterns and prognosis of R0 resection(414 cases)and R1 resection(26 cases)were compared.Result Before propensity matching,there were statistically significant differences in N stage and peritumor intravascular cancer embol between R0 resection and R1 resection in patients with locally advanced gastric cancer(P<0.05).After propensity matching,there were no significant differences in various clinical features between R0 resection and R1 resection in patients with locally advanced gastric cancer(P>0.05).There was no significant difference in recurrence pattern between R0 resection and R1 resection in patients with locally advanced gastric cancer(P>0.05).Before propensity matching,there were statistically significant differences in overall survival and relapse-free survival between R0 resection and R1 resection in patients with locally advanced gastric cancer(P<0.01).After propensity matching,there were no significant differences in overall survival and relapse-free survival between R0 resection and R1 resection in patients with locally advanced gastric cancer(P>0.05).After propensity matching,there was no significant difference in the survival of R1 resection patients with locally advanced gastric cancer treated with different chemotherapy regimen(P>0.05).Conclusion R1 resection in patients with locally advanced gastric cancer is usually associated with later stage,worse biological behavior and prognosis.Postoperative adjuvant therapy for patients with R1 resection gastric cancer should be based on the principle that local therapy does not affect systemic drug therapy.

关 键 词：胃癌 切缘肿瘤细胞残留 R1切除 辅助化疗 复发模式 预后 

分 类 号：R735.2[医药卫生—肿瘤]