局部进展期胃癌新辅助化疗联合免疫治疗术后复发模式及预后  

The postoperative recurrence pattern and prognosis of locally advanced gastric cancer after neoadjuvant chemotherapy combined with immunotherapy

作　　者：尹玉平 孙雄 丁嘉宁 李天昊 吴轲 刘科 李桉树 帅晓明[1] 蔡开琳 王征[1] 王国斌[1] 张鹏[1] 陶凯雄[1] Yin Yuping;Sun Xiong;Ding Jianing;Li Tianhao;Wu Ke;Liu Ke;Li Anshu;Shuai Xiaoming;Cai Kailin;Wang Zheng;Wang Guobin;Zhang Peng;Tao Kaixiong(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,湖北武汉430022

出　　处：《腹部外科》2025年第2期105-111,共7页Journal of Abdominal Surgery

基　　金：国家自然科学基金(82072736,82003205,82373123,82473175);湖北省重点研发计划(2021BCA116);湖北省自然科学基金(2024AFB655)。

摘　　要：目的分析局部进展期胃癌在接受新辅助化疗联合免疫治疗后行胃癌D2根治术的预后影响因素及复发模式。方法选取2020年1月至2023年10月间在华中科技大学同济医学院附属协和医院胃肠外科接受新辅助化疗联合免疫治疗并行胃癌D2根治术的76例局部进展期胃癌病人,根据术后复发情况分为复发组(22例)和未复发组(54例)。收集其临床和随访资料并进行分析。结果单一复发模式病人14例(63.6%),其中局部复发、区域复发、腹腔转移、远处转移的病人占比分别为4.5%、4.5%、4.5%、50.1%。未复发组与复发组在神经侵犯、血管侵犯、ypT分期及ypN状态的比较中,差异均有统计学意义(均P<0.05)。单因素分析显示,印戒细胞癌、神经侵犯、血管侵犯、ypT分期及ypN状态是影响局部进展期胃癌病人接受新辅助化疗免疫治疗并行D2根治术后无病生存期的相关因素(均P<0.05)。多因素分析结果表明,印戒细胞癌(P=0.048)和ypN状态(P=0.035)是局部进展期胃癌接受新辅助化疗免疫治疗并行D2根治术后无病生存期的独立影响因素。淋巴结病理完全缓解组(ypN0组)和淋巴结转移组(ypN+组)病人双重复发发生率上存在显著差异。结论印戒细胞癌、ypN状态是局部进展期胃癌在接受新辅助化疗联合免疫治疗术后无病生存期的独立预后因素。局部进展期胃癌在接受新辅助化疗联合免疫治疗术后需重点预防远处复发,以进一步改善病人的长期预后。Objective To analyze the prognostic factors and recurrence patterns of locally advanced gastric cancer(LAGC)patients who underwent D2 radical gastrectomy after receiving neoadjuvant chemotherapy combined with immunotherapy.Methods A total of 76 LAGC patients who received neoadjuvant chemotherapy combined with immunotherapy followed by D2 radical gastrectomy at the Department of Gastrointestinal Surgery,Union Hospital,Huazhong University of Science and Technology,from January 2020 to October 2023,were enrolled.According to postoperative recurrence,patients were divided into the recurrence group(22 cases)and non-recurrence group(54 cases).Clinical and follow-up data were collected.Results There were 14 patients with a single recurrence mode(63.6%),and the proportion of patients with local recurrence,regional recurrence,abdominal metastasis and distant metastasis was 4.5%,4.5%,4.5%,and 50.1%,respectively.Statistically significant differences were found between the recurrence and non-recurrence groups in terms of nerve invasion,vascular invasion,posttreatment pathological tumor(ypT)staging and posttreatment pathological lymph node(ypN)status(all P<0.05).Univariate analysis revealed that signet-ring cell carcinoma,nerve invasion,vascular invasion,ypT stage,and ypN status were significantly related with disease-free survival(DFS)after D2 radical gastrectomy in LAGC patients receiving neoadjuvant chemotherapy and immunotherapy(all P<0.05).Multivariate analysis showed that signet-ring cell carcinoma(P=0.048)and ypN status(P=0.035)were independent factors affecting DFS after D2 radical gastrectomy.Additionally,there was a significant difference in the incidence of double recurrence between the ypN0 group and the ypN+group patients.Conclusion Signet-ring cell carcinoma and ypN status are independent prognostic factors for LAGC after neoadjuvant chemotherapy combined with immunotherapy and surgery.Preventing distant recurrence after neoadjuvant chemotherapy combined with immunotherapy and surgery is an important approach to

关 键 词：胃癌 局部进展期 D2根治术 新辅助治疗 免疫治疗 复发 

分 类 号：R656.6[医药卫生—外科学]