以动脉灌注化疗为基础术前治疗中晚期胃癌的单中心真实世界研究  

Efficacy and prognosis of preoperative treatment based on arterial infusion chemotherapy in patients with advanced gastric cancer:a real-world study

作　　者：相小松 郭飞龙 苏钰 马龙 史东鸿 刘蕾蕾 李国立 Xiang Xiaosong;Guo Feilong;Su Yu;Ma Long;Shi Donghong;Liu Leilei;Li Guoli(Research Institute of General Surgery,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China;Department of General Medicine,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China;Department of Medical Imaging,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China;Department of Pathology,General Hospital of Eastern Theater Command,PLA,Nanjing 210002,China)

机构地区：[1]解放军东部战区总医院普通外科,南京210002 [2]解放军东部战区总医院全科医学科,南京210002 [3]解放军东部战区总医院医学影像科,南京210002 [4]解放军东部战区总医院病理科,南京210002

出　　处：《中华肿瘤杂志》2025年第2期183-192,共10页Chinese Journal of Oncology

基　　金：江苏省医学创新中心建设专项(CXZX202217);江苏省卓越博士后计划(2022ZB750);东部战区总医院临床研究专项(22LCYY-XH11)。

摘　　要：目的探讨以动脉灌注化疗为基础的术前治疗(PTAC)治疗中晚期胃癌患者的疗效和预后。方法收集2001年1月至2021年1月在解放军东部战区总医院接受PTAC治疗的全部821例中晚期胃癌患者的临床和随访资料,依据治疗药物方案分为FLEEOX组(89例)、XEEOX组(196例)、SEEOX组(406例)和SEEOX+PD-1组(130例)。首要研究指标为3年无进展生存率,次要研究指标包括3年总生存率、客观反应率、根治性切除率、主要病理缓解率、不良反应发生率等。结果821例患者PTAC治疗后,客观缓解率为74.9%(615/821),共有671例患者接受了根治手术,根治性切除率为81.7%,R0切除率为70.2%(576/821)。病理完全缓解率为16.7%(112/671),主要病理缓解率为32.2%(216/671)。平均随访27.7个月,3年无进展生存率为52.2%,3年总生存率为55.8%。SEEOX+PD-1组患者的3年无进展生存率为66.9%,客观缓解率为83.8%(109/130),主要病理缓解率为45.3%(53/117),根治性切除率为90.0%(117/130),均优于XEEOX组和SEEOX组(均P<0.05)。但治疗期间SEEOX+PD-1组有3例患者因发生免疫相关不良反应导致死亡。结论PTAC治疗是一种有效的中晚期胃癌术前治疗方法,联合PD-1单抗等免疫治疗有望进一步提高治疗效果。Objective To explore the efficacy and prognosis of preoperative treatment based on arterial infusion chemotherapy(PTAC)in patients with advanced gastric cancer.Methods Clinical and follow-up data of 821 patients with advanced gastric cancer who received PTAC treatment at the General Hospital of the Eastern Theater Command of the People's Liberation Army from January 2001 to January 2021 were collected.According to the treatment regimen,patients were divided into the FLEEOX group(89 cases),the XEEOX group(196 cases),the SEEOX group(406 cases),and the SEEOX+PD-1 group(130 cases).The primary endpoint was the 3-year progression-free survival rate.Secondary endpoints included the 3-year overall survival rate,objective response rate,radical resection rate,major pathological response rate,and incidence of treatment associated adverse events.Results After PTAC treatment,the objective response rate was 74.9%(615/821).A total of 671 patients underwent radical surgery,with a radical resection rate of 81.7%and an R0 resection rate of 70.2%(576/821).The pathological complete response rate was 16.7%(112/671),and the major pathological response rate was 32.2%(216/671).With an average follow-up of 27.7 months,the 3-year progression-free survival rate was 52.2%,and the 3-year overall survival rate was 55.8%.The 3-year progression-free survival rate of patients in the SEEOX+PD-1 group was 66.9%,the objective response rate was 83.8%(109/130),the major pathological response rate was 45.3%(53/117),and the radical resection rate was 90.0%(117/130),all of which were better than those in the XEEOX and SEEOX groups(all P<0.05).However,during the treatment period,three patients in the SEEOX+PD-1 group died from immune-related adverse events.Conclusion PTAC treatment is an effective preoperative treatment method for advanced gastric cancer,and is expected to further improve the treatment effect when combined with immunotherapy such as PD-1 monoclonal antibodies.

关 键 词：胃腺癌 经导管动脉灌注化疗 术前治疗 免疫治疗 

分 类 号：R73[医药卫生—肿瘤]