新辅助化疗后区域淋巴结降期至ypN0对cT4N+ 胃癌/胃食管交界腺癌患者的生存有积极影响。
Nodal downstaging to ypN0 after neoadjuvant chemotherapy positively impacts on survival of cT4N+ GC/GEJ patients.
作者信息
Wu Liucheng, Xing Zhaoqiong, Huang Mingwei, Yu Hongping, Qin Yuzhou, Jin Qinwen, Zhou Zihan, Chen Jiansi
机构信息
Department of Gastrointestinal Surgery, Guangxi Cancer Hospital and Guangxi Medical University Affiliated Cancer Hospital, Nanning, Guangxi, China.
Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
出版信息
J Surg Oncol. 2022 Dec;126(8):1403-1412. doi: 10.1002/jso.27065. Epub 2022 Aug 24.
BACKGROUND
The prognostic value of histomorphologic regression in primary gastric and gastroesophageal cancers (GC/GEJ) has been previously established, however, the impact of lymph node (LN) regression on survival still remains unclear.
METHODS
A prospectively maintained database was reviewed to identify cT4N+ gastric and gastroesophageal cancers (GC/GEJ) after NAC (neoadjuvant chemotherapy). Patients were categorized into two groups based on LN status: cN+/ypN0 (downstaged N0) and cN+/ypN+ (persistent N+), long-term survival were analyzed using Kaplan-Meier survival estimates.
RESULTS
In total, 125 patients with cT4N+ GC/GEJ underwent NAC followed by surgery were enrolled. A total of 39 patients (31.2%) had cN+/ypN0 (ypN0) disease, 86 patients (68.8%) had cN+/ypN+ (ypN+) disease. Prognosis in ypN+ patients was significantly worse than those in ypN0 group for 3- and 5-year overall survival (OS) (p < 0.05). The 3-year OS was 83%, 44% in ypN0 and ypN+ group, respectively. The 5-year OS was 75%, 35% in ypN0 and ypN+ group, respectively. Multivariable analysis suggested that multivisceral resection (hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.14-0.76, p = 0.009), and ypN+ (HR = 3.42, 95% CI: 1.15-10.13, p =0.027) were independent prognostic factors for OS.
CONCLUSION
Nodal downstaging is an important hallmark representing the effectiveness of NAC for GC/GEJ, and it positively impacts on survival of these patients.
背景
组织形态学退缩在原发性胃癌和胃食管交界癌（GC/GEJ）中的预后价值此前已得到证实，然而，淋巴结（LN）退缩对生存的影响仍不明确。
方法
回顾一个前瞻性维护的数据库，以识别接受新辅助化疗（NAC）后的cT4N+胃癌和胃食管交界癌（GC/GEJ）患者。根据LN状态将患者分为两组：cN+/ypN0（降期至N0）和cN+/ypN+（持续N+），使用Kaplan-Meier生存估计分析长期生存情况。
结果
总共125例cT4N+ GC/GEJ患者接受了NAC然后手术。共有39例患者（31.2%）为cN+/ypN0（ypN0）疾病，86例患者（68.8%）为cN+/ypN+（ypN+）疾病。ypN+患者的3年和5年总生存（OS）预后明显比ypN0组差（p < 0.05）。ypN0组和ypN+组的3年OS分别为83%、44%。5年OS分别为75%、35%。多变量分析表明，多脏器切除（风险比[HR]=0.33，95%置信区间[CI]：0.14 - 0.76，p = 0.009）和ypN+（HR = 3.42，95%CI：1.15 - 10.13，p = 0.027）是OS的独立预后因素。
结论
淋巴结降期是代表NAC对GC/GEJ有效性的重要标志，并且对这些患者的生存有积极影响。
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