21例新辅助化疗后病理完全缓解胃癌患者临床特征及预后
分析
彭良群;杨巍;张占东;刘洪兴;花亚伟
【期刊名称】《中华胃肠外科杂志》 【年(卷),期】2017(020)010
【摘要】Objective To evaluate the clinical features and prognosis of gastric cancer patients with pathological complete response(pCR)after neoadjuvant chemotherapy(NAC). Methods Clinical data of 159 gastric cancer patients who received NAC followed by surgical resection between January 2012 and December 2014 at the Affiliated Tumor Hospital of Zhengzhou University were collected and clinical features of those with pCR were analyzed retrospectively. Kaplan-Meier method was used to estimate 3-year overall survival(OS)rate and recurrence-free survival(RFS)rate. Recurrence factors were analyzed by univariate and multivariate analysis with Cox proportional hazard model. Results A total of 21 patients(13.2%)achieved pCR, including 13 male and 8 female cases, with the median age at diagnosis of 56 (40 to 70)years. Eleven cases were differentiated tumor and 10 were undifferentiated. Six cases were in clinical baseline stageⅡ, and 15 were in Ⅲ. Five cases received the mFOLFOX6(oxaliplatin + leucovorin +5-FU), 6 received the SOX(oxaliplatin +S-1), 4 received the XELOX(oxaliplatin +capecitabine), 2 received the EOX(epirubicin + oxaliplatin +capecitabine)and 4
received the DOX (docetaxel + oxaliplatin +capecitabine)chemotherapy regimens. Two cases achieved CR, 18 achieved PR, and 1 was SD after NAC. The median(range)course of preoperative and postoperative chemotherapy were 4(2 to 5)and 2(0 to 5). All the patients underwent R0 resection plus D2 lymphadenectomy, and 4 cases were performed with proximal gastrectomy, 3 cases were performed with distal gastrectomy, 13 cases were performed with total gastrectomy, and one case was performed with total gastrectomy plus pancreatic splenectomy. Pneumonia, abdominal bleeding and infection, anastomotic leakage, and gastroplegia occurred respectively in one case, who all were cured by conservative treatment. The median follow-up of the survivors was 39.3(range 22.7 to 56.9)months. Three cases died of recurrence: 1 case in the liver, 1 in the lung, and 1 in the brain. Two cases developed recurrence and survived: 1 in the liver and 1 in celiac lymph nodes. The overall survival and 3-year recurrence-free survival rates were 90.2%(95%CI: 100 to 77.3)and 90.5%(95%CI: 100 to 78.0). Fourteen cases did not complete scheduled chemotherapy course, and the overall 3-year survival rate was 85.1%. Older age(> 50 years old)(P=0.028, RR = 0.063, 95%CI: 0.005 to 0.743)and no postoperative complication (P = 0.023, RR= 0.065, 95%CI: 0.006 to 0.689)were identified as independent prognostic factors with Cox multivariate analysis. Conclusion Patients diagnosed as gastric cancer with pCR after
NAC have good prognosis, but the pCR ratio is low, and those with younger age and more postoperative complications may have higher risk for recurrence and metastasis.%目的 探讨新辅助化疗后病理完全缓解(pCR)胃癌患者的临床特征及预后.方法 回顾性收集2012年1月至2014年12月在郑州大学附属肿瘤医院接受新辅助化疗后行手术治疗的159例胃癌患者的临床资料,分析达到pCR患者的临床特征,采用Kaplan-Meier法估计pCR患者的总生存率(OS)和无复发生存率(RFS),采用Cox比例风险模型来分析pCR患者复发的危险因素.结果 共21例(13.2%)患者达到pCR,其中男13例,女8例;年龄40 ~ 70(中位数56)岁;组织学分型:分化型11例,未分化型10例.治疗前临床TNM分期Ⅱ期6例,Ⅲ期15例.术前5例行mFOLFOX6方案(奥沙利铂、亚叶酸钙、氟尿嘧啶)化疗,6例行SOX方案(替吉奥胶囊、奥沙利铂)化疗,4例行XELOX方案(卡培他滨、奥沙利铂)化疗,2例行EOX方案(表阿霉素、奥沙利铂、卡培他滨)化疗,4例行DOX方案(多西他赛、奥沙利铂、卡培他滨)化疗.术前化疗周期中位数4(2~5)周期,术前化疗效疗效评估:2例完全缓解(CR)、18例部分缓解(PR)、1例疾病稳定(SD).21例患者均接受胃癌D2根治术,其中4例行近端胃癌根治术,3例行远端胃癌根治术,13例行全胃切除术,1例行全胃联合胰体尾脾切除术,均为R0切除.术后出现肺部感染、腹腔出血与感染、吻合口瘘及胃瘫各1例,均经保守治疗治愈.术后化疗周期中位数2(0~5)周期.全组中位随访时间为39.3 (22.7~56.9)月,无患者失访.3例患者死亡,分别为肝转移、肺转移和脑转移各1例;肝转移和腹腔淋巴结转移各1例患者仍存活.全组3年OS为90.2%(95%CI:0.773~1.000),3年RFS为90.5%(95%CI:0.780~1.000).14例未完成预定的化疗周期,其3年OS为85.1%.多因素分析显示,年龄>50岁
21例新辅助化疗后病理完全缓解胃癌患者临床特征及预后分析
