术前使用免疫检查点抑制剂对胃癌转移淋巴结癌残留影响的回顾性研究  

Effect of preoperative immune checkpoint inhibitors on reducing residual lymph node metastases in patients with gastric cancer:a retrospective study

作　　者：陈新华 林和新 陈粤泓 王晓东 刘超群 黄慧琳 梁华元 张惠敏 李风萍[1] 刘浩[1] 胡彦锋[1] 李国新[1] 尤俊[2] 赵丽瑛 余江[1] Chen Xinhua;Lin Hexin;Chen Yuehong;Wang Xiaodong;Liu Chaoqun;Huang Huilin;Liang Huayuan;Zhang Huimin;Li Fengping;Liu Hao;Hu Yanfeng;Li Guoxin;You Jun;Zhao Liying;Yu Jiang(Department of General Surgery&,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastrointestinal Oncology Surgery,The Firsit Affiliated Hospital of Xiamen University,Xiamen 361000,China;Department of Pathology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院普通外科,广州510515 [2]厦门大学附属第一医院胃肠肿瘤外科,厦门361000 [3]南方医科大学南方医院病理科,广州510515 [4]广东省胃肠肿瘤精准微创诊疗重点实验室,广州510515

出　　处：《中华胃肠外科杂志》2024年第7期694-701,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省胃肠肿瘤精准微创诊疗重点实验室(2020B121201004);南方医科大学南方医院临床研究专项(2023CR017);北京科创医学发展基金会(KC2023-JX-0186-FQ043)。

摘　　要：目的:探讨术前使用免疫检查点抑制剂能否减少胃癌转移淋巴结的癌残留。方法:采用回顾性研究方法,收集2014年1月至2023年12月期间南方医科大学南方医院和厦门大学附属第一医院行术前系统治疗,且D 2根治术后病理提示原发灶退缩分级为肿瘤退缩分级(TRG)1级的胃腺癌患者,排除术前接受放疗的患者。共纳入58例患者(南方医科大学南方医院:46例;厦门大学附属第一医院:12例),根据术前用药方案的不同,分为术前单纯化疗组(36例)和术前免疫联合化疗组(22例)。两组患者的性别、年龄、体质指数、合并糖尿病、肿瘤位置、病理分型、Lauren分型、肿瘤分化程度、治疗前肿瘤原发灶浸润深度、治疗前淋巴结分期、治疗前临床分期、错配修复蛋白状态、术前治疗周期和术前治疗间隔时间比较,差异均无统计学意义(均P>0.05)。主要观察指标为两组术后淋巴结降期情况,次要观察指标包括术后肿瘤浸润深度和淋巴结检出数目,以及影响原发灶TRG1级胃癌患者淋巴结癌残留的因素。结果:术前免疫联合化疗组治疗后淋巴结降期显著优于术前单纯化疗组[pN0:90.9%(20/22)比61.1%(22/36);pN1:4.5%(1/22)比36.1%(13/36);pN2:4.5%(1/22)比0;pN3:0比2.8%(1/36),Z=-2.315,P=0.021]。术前免疫联合化疗组与单纯化疗组比较,术后送检淋巴结数目[(40.5±16.3)枚比(40.8±17.5)枚,t=0.076,P=0.940]和治疗后原发灶浸润深度[pT1a:50.0%(11/22)比30.6%(11/36);pT1b:13.6%(3/22)比19.4%(7/36);pT2:13.6%(3/22)比13.9%(5/36);pT3:13.6%(3/22)比25.0%(9/36);pT4a:9.1%(2/22)比11.1%(4/36),Z=-1.331,P=0.183]比较,差异均无统计学意义。单因素分析结果显示,术前治疗方案与原发灶TRG 1级胃癌患者淋巴结癌残留有关(χ^(2)=6.070,P=0.014)。除术前治疗方案外,另外选取治疗前肿瘤原发灶浸润深度、治疗前淋巴结分期、治疗前临床分期、术前治疗周期和术前治疗间隔时间等临床上考虑可能与淋Objective To investigate the effect of immune checkpoint inhibitors on reducing residual lymph node metastasis in patients with gastric cancer.Methods The cohort of this retrospective study comprised patients from Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Xiamen University who had undergone systemic treatment prior to gastrectomy with D2 lymphadenectomy and had achieved Grade 1 primary tumor regression(TRG1)from January 2014 to December 2023.After exclusion of patients who had undergone preoperative radiotherapy,data of 58 patients(Nanfang Hospital:46;First Affiliated Hospital of Xiamen University:12)were analyzed.These patients were allocated to preoperative chemotherapy(Chemotherapy group,N=36 cases)and preoperative immunotherapy plus chemotherapy groups(Immunotherapy group,N=22 cases).There were no significant differences between these groups in sex,age,body mass index,diabetes,tumor location,pathological type,Lauren classification,tumor differentiation,pretreatment depth of invasion by primary tumor,pretreatment lymph node stage,pretreatment clinical stage,mismatch repair protein status,number of preoperative treatment cycles,or duration of preoperative treatment(all P>0.05).The primary outcome measure was postoperative lymph node downstaging.Secondary outcomes included postoperative depth of invasion by tumor,number of lymph nodes examined,and factors affecting residual lymph node metastasis status.Results Lymph node downstaging was achieved significantly more often in the Immunotherapy group than the Chemotherapy group(pN0:90.9%[20/22]vs.61.1%[22/36];pN1:4.5%[1/22]vs.36.1%[13/36];pN2:4.5%[1/22]vs.0;pN3:0 vs.2.8%[1/36],Z=-2.315,P=0.021).There were no significant difference between the two groups in number of lymph nodes examined(40.5±16.3 vs.40.8±17.5,t=0.076,P=0.940)or postoperative depth of invasion by primary tumor(pT1a:50.0%[11/22]vs.30.6%[11/36];pT1b:13.6%[3/22]vs.19.4%[7/36];pT2:13.6%[3/22]vs.13.9%[5/36];pT3:13.6%[3/22]vs.25.0%[9/36];pT4a:9.1%[2/22]vs.11.1%[

关 键 词：胃肿瘤 术前治疗 免疫治疗 免疫检查点抑制剂 化疗 淋巴结 癌残留 

分 类 号：R735.2[医药卫生—肿瘤]