摘要
目的比较新辅助化疗和辅助化疗两种治疗模式对局部进展期胃癌患者的预后影响。方法回顾性队列分析2012年1月至2014年12月期间，郑州大学附属肿瘤医院行开腹D2根治术的局部进展期胃癌患者的临床资料，其中行新辅助化疗患者65例（新辅助化疗组），行术后辅助化疗患者1243例（辅助化疗组）。病例入组标准：（1）年龄为18~75岁、经胃镜活检病理证实为胃腺癌的患者；（2）手术方式均为开腹D2根治术；（3）影像学检查未见远处转移及不可切除因素。排除未行开腹手术、腹腔镜手术、新辅助化疗疗程〈2周期、未行辅助化疗、其他恶性肿瘤病史以及有严重并发症和资料不全者。采用SOX（替吉奥加奥沙利铂）或XELOX（卡培他滨加奥沙利铂）作为新辅助化疗和术后辅助化疗方案。应用倾向评分匹配法对两组进行1∶2最小毗邻法匹配，得到组间协变量均衡的样本，采用Kaplan-Meier法进行生存分析。结果对两组患者的性别、年龄、肿瘤部位、分化程度、临床分期、化疗方案、化疗周期及手术方式8个因素进行倾向评分匹配后，共195例患者纳入本研究，其中新辅助化疗组65例，辅助化疗组130例。新辅助化疗组淋巴结清扫数目（22.3±4.6）枚，辅助化疗组为（22.6±5.1）枚，两组比较，差异均无统计学意义（t=1.125，P=0.263）。对新辅助化疗组患者采用肿瘤退缩分级（TRG）进行术后病理学疗效评估：完全退缩（TRG0）6例，中等退缩（TRG1）8例，轻微退缩（TRG2）17例，无退缩（TRG3）34例；新辅助化疗敏感（TRG0~2）31例（47.7%），不敏感（TRG3）34例（52.3%）。新辅助化疗组的3年无进展生存率和总生存率分别为73.6%（95%CI：62.8~84.3）和80.0%（95%CI：70.2~89.8）；辅助化疗组分别为69.9%（95%CI：62.1~77.7）和74.6%（95%CI：67.2~82.0）；两组比较，差异均无统计学意义（P=0.361和P=0.
ObjectiveTo compare the effects of neoadjuvant chemotherapy and adjuvant chemotherapy on the prognosis of patients with locally advanced gastric cancer using propensity score matching method.
MethodsClinical data of patients with locally advanced gastric cancer undergoing open D2 radical gastrectomy between January 2012 and December 2014 at the Affiliated Tumor Hospital of Zhengzhou University were analyzed retrospectively. Sixty-five patients receiving neoadjuvant chemotherapy （NAC） were allocated into the NAC group and 1243 patients receiving postoperative adjuvant chemotherapy （AC） were allocated into the AC group. Inclusion criteria： （1） age ranged from 18 to 75 years old, and biopsy specimen was confirmed as adenocarcinoma; （2） all the operative procedures were open D2 radical gastrectomy; （3） image examinations showed no distant metastasis or other unresectable factors. Exclusion criteria： no open D2 radical gastrectomy, undergoing laparoscopic surgery, neoadjuvant chemotherapy course 〈2 cycles, without adjuvant chemotherapy, history of other malignancies, severe complications, incomplete data. SOX （tegafur-gimeracil-oteracil plus oxaliplatin） or XELOX （capecitabine plus oxaliplatin） was used as neoadjuvant and postoperative adjuvant chemotherapy regimen. One-to-two propensity score matching was performed to balance the covariance between two groups. Survival was analyzed using the Kaplan-Meier method. Differences between the curves were tested using log-rank test.
ResultsAfter balancing the covariates including gender, age, tumor location, degree of differentiation, clinical stage, chemotherapy regimen, chemotherapy course and surgical approach, 195 patients were enrolled, including 65 patients of the NAC group and 130 patients of the AC group. The number of harvested lymph nodes in NAC and AC group was 22.3±4.6 and 22.6±5.1 respectively, without statistically significant difference （t=1.125, P=0.263） . Pathological response assessment for NAC group showed TRG0
作者
彭良群
杨巍
张占东
郅重阳
周信方
刘洪兴
花亚伟
Peng Liangqun;Yang Wei;Zhang Zhandong;Zhi Chongyang;Zhou Xinfang;Liu Hongxing;Hua Yawei(Department of General Surgery,The Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第10期1148-1153,共6页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
新辅助化疗
倾向评分匹配
预后
Stomach neoplasms
Neoadjuvant chemotherapy
Propensity score matching
Prognosis
