中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (10): 1156-1159.DOI: 10.19538/j.cjps.issn1005-2208.2022.10.17

• 论著 • 上一篇    下一篇

经新辅助或转化治疗术后分期为ypT0~1NanyM0局部进展期胃癌54例预后分析

郭飞龙，马    龙，相小松，李国立   

  1. 中国人民解放军东部战区总医院普通外科，江苏南京 210002
  • 出版日期:2022-10-01 发布日期:2022-10-13

  • Online:2022-10-01 Published:2022-10-13

摘要： 目的    分析经新辅助或转化治疗术后分期为ypT0~1NanyM0的局部进展期胃癌病人的长期预后。方法  回顾性分析2008年1月至2020年1月中国人民解放军东部战区总医院普外科收治的经新辅助或转化治疗后行根治性切除手术，且术后分期为ypT0~1NanyM0的54例局部进展期胃癌病人的临床资料，应用Kaplan-Meier法计算病人3年和5年的总体生存率及无进展生存率，并比较术后分期为ypT0N0M0与ypT1N0M0病人之间的生存差异。结果    共纳入54例局部进展期胃癌病人。10例（18.5%）病人术前接受常规给药途径的SOX化疗方案，44例采用动静脉结合的化疗方法，其中31例（57.4%）为SEEOX方案，13例（24.1%）为FLEEOX方案。所有病人均实施D2或D2+淋巴结清扫，并获得R0切除。30例（55.6%）病人行全胃切除术，24例（44.4%）行远端胃切除术。术后分期为ypT0N0M0病人38例（70.4%），ypT1N0M0病人11例（20.4%）。所有病人术后均接受辅助化疗。随访56.5（13.1～170.3）个月，共有15例病人死亡，其中11例病人因肿瘤局部复发或远处转移死亡，复发转移时间为18.9（7.8～55.5）个月。3年和5年总体生存率分别为83.2%和76.4%，3年和5年无进展生存率分别为83.1%和72.8%。分期为ypT0N0M0与ypT1N0M0病人生存时间比较结果显示，总体生存时间［中位生存时间为尚未达到（NR） vs. 5.2年，HR=0.46，95%CI 0.12-1.68，P=0.138］和无进展生存时间（NR vs 4.6年，HR=0.57，95%CI 0.15-2.20，P=0.337）差异均无统计学意义。结论  经新辅助或转化治疗术后分期为ypT0~1NanyM0 的局部进展期胃癌病人长期预后较好，且ypT1N0M0与ypT0N0M0病人的长期生存时间相近。

关键词: 胃癌, 新辅助化疗, 转化治疗, 局部晚期胃癌, 术后病理分期

Abstract: Long-term prognosis of fifty-four patients with locally advanced gastric cancer downstaged to ypT0-1NanyM0 following neoadjuvant or conversion therapy        GUO Fei-long，MA Long，XIANG Xiao-song，et al. Department of General Surgery，General Hospital of Eastern Theater Command of PLA，Nanjing 210002，China 
Corresponding author：LI Guo-li，E-mail: drguoli@163.com
Abstract    Objective    To detect the long-term survival of patients with locally advanced gastric cancer (LAGC) who achieved ypT0-1NanyM0 after neoadjuvant chemotherapy or conversion therapy. Methods    Fifty-four LAGC patients who achieved ypT0-1NanyM0 following neoadjuvant chemotherapy or conversion therapy between January 2008 and January 2020 at Jinling Hospital，School of Medicine，Nanjing University were retrospectively analyzed. The 3- and 5-year overall survival (OS) and progression-free survival (PFS) rates were calculated with Kaplan-Meier method, and survival between ypT0N0M0 and ypT1N0M0 patients was compared with Log-rank test. Results    A total of 54 patients were recruited in our study. About preoperative chemotherapy regimens, ten (18.5%) patients received the conventional SOX regimen, and 44 patients received the intra-arterial and intravenous combined chemotherapy, among which 31 (57.4%) patients received the SEEOX regimen and 13 (24.1%) patients received the FLEEOX regimen. R0 resection together with D2 or D2+ lymphadenectomy was applied in all patients. Thirty (55.6%) patients underwent total gastrectomy, and 24 (44.4%) patients underwent distal gastrectomy. ypT0N0M0 and ypT1N0M0 were respectively achieved in 38 (70.4%) and 11 (20.4%) cases. All patients received adjuvant chemotherapy. With the median follow-up period of 56.5（range 13.1-170.3） months，15 patients died, among whom 11 patients died of regional tumor recurrence or metastasis with the median progression time of 18.9 (7.8- 55.5) months. The 3- and 5-year OS rates were 83.2% and 76.4% respectively，and the 3- and 5-year PFS rates were 83.1% and 72.8%. No remarkable significance was detected in both OS (NR vs 5.2y, HR=0.46，95%CI 0.12-1.68，P=0.138) and PFS (NR vs 4.6y, HR=0.57，95%CI 0.15-2.20，P=0.337) between ypT0N0M0 and ypT1N0M0 patients. Conclusion  LAGC patients who achieved ypT0-1NanyM0 exhibited favorable long-term survival outcomes, and the long-term survival were comparable in ypT1N0M0 and ypT0N0M0 subgroups.

Key words: gastric cancer, neoadjuvant chemotherapy, conversion therapy, locally advanced gastric cancer, ypTNM staging