中国实用外科杂志

中国实用外科杂志

• 论著 • 上一篇    下一篇

基于临床特征的局部进展期胃癌新辅助化疗效果分析及获益人群筛选研究#br#

刘友东，陈    杰，龙子雯，陆    俊，刘晓文，刘凤林   

  1. 复旦大学附属肿瘤医院胃外二科 复旦大学上海医学院肿瘤学系，上海 200032
  • 出版日期:2025-04-01

  • Online:2025-04-01

摘要： 目的    分析接受新辅助化疗的局部进展期胃癌病人的临床特征及治疗效果，探讨胃癌新辅助化疗的潜在获益人群筛选条件。方法    回顾性分析2017年6月至2022年12月复旦大学附属肿瘤医院胃外科收治的接受新辅助化疗后行胃癌D2根治术的267例局部进展期胃癌病人的临床病理资料。根据术后病理学肿瘤退缩分级评估新辅助化疗的效果，分为获益组（157例）与不获益组（110例）。对比两组病人新辅助化疗前后各项指标，采用Logistic回归模型进行预测因素分析。结果    获益组和不获益组病人接受新辅助化疗前的临床N分期、肿瘤Lauren分型、印戒细胞癌类型、血清肿瘤标记物（CA19-9和CA72-4）水平差异有统计学意义（P<0.05）。术后病理学检查结果示，两组肿瘤大小、病理T和N分期、脉管浸润及神经侵犯方面差异有统计学意义（P<0.05）。两组病人总生存期和无复发生存期差异有统计学意义（P<0.05），且获益群体生存期延长。多因素分析结果显示，临床N分期早（OR=0.087，95%CI 0.019-0.401，P=0.002）、Lauren分型非弥漫型（OR=0.625，95%CI 0.431-0.906，P=0.013）、非印戒细胞癌（OR=3.178，95%CI 1.701-5.937，P＜0.001）是局部进展期胃癌病人新辅助化疗获益的独立影响因素。结论    局部进展期胃癌病人中新辅助化疗获益者的特点主要包括临床N分期早、Lauren分型非弥漫型、非印戒细胞癌、血清肿瘤标记物表达水平低、肿瘤直径小、无脉管和神经侵犯；临床早期N分期、非弥漫型胃癌以及非印戒细胞癌是影响局部进展期胃癌病人新辅助化疗获益的独立预测因素，联合指标分析有助于及时调整肿瘤综合治疗策略。

关键词: 胃肿瘤, 局部进展期, 新辅助化疗, 肿瘤退缩分级, 治疗效果

Abstract: To observe the clinical characteristics and therapeutic effects of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer, and to explore the potential beneficial population of NAC for gastric cancer. Methods    Clinical data of patients with locally advanced gastric cancer after NAC undergoing D2 radical gastrectomy between June 2017 and December 2022 at Fudan University Shanghai Cancer Center were analyzed retrospectively. According to the postoperative pathological evaluation, they were divided into the NAC benefit group (n=157) and the non-benefit group (n=110). The clinical characteristics between the benefit group and the non-benefit group before and after NAC were compared and the logistic regression model was used to identify predictive factors for benefit group. Results    There were statistically significant differences in cN stage, Lauren classification, signet ring cell carcinoma type, and serum expression of tumor marker CA19-9 and CA72-4 (P<0.05) between the two groups before NAC. The postoperative pathological examination results showed that there were also significant differences in tumor size, ypT and ypN stages, vascular invasion, and neural invasion (P<0.05) between the two groups. The differences in overall survival time and relapse-free survival time between patients were also statistically significant, with longer survival time in the benefit group (P<0.05). Multivariate analysis revealed that early cN stage (OR=0.087, 95%CI 0.019-0.401, P=0.002), non-diffuse type (OR=0.625, 95%CI 0.431-0.906, P=0.013), non-signet ring cell carcinoma (OR=3.178, 95%CI 1.701-5.937, P<0.001) were identified as independent predictors of the benefit of NAC in patients with locally advanced gastric cancer. Conclusion    The characteristics of patients with locally advanced gastric cancer who benefit from NAC include early cN stage, non-diffuse type, non-signet ring cell carcinoma, low expression of serum tumor marker, small tumor diameter, and absence of vascular invasion and neural invasion. Early cN stage, non-diffuse type and non-signet ring cell carcinoma are independent predictive factors for the benefit of NAC in patients with locally advanced gastric cancer. Joint analysis of these factors contributes to timely adjust the comprehensive treatment strategy for patients with locally advanced gastric cancer.

Key words: stomach neoplasms, locally advanced, neoadjuvant therapy, tumor regression grade, treatment outcomes