进展期胃癌新辅助化疗后CT缓解程度与病理反应的预后价值

Progrnosis value of CT histopathological regression in advanced gastric cancer after neoadjuvant chemotherapy

目的探讨胃癌新辅助化疗后CT缓解程度、病理反应程度及二者与患者生存期之间的关系。方法将120例符合入组条件的进展期胃癌病例,分为化疗+手术组和常规手术组,化疗+手术组患者术前行FOLFOX-7方案化疗2周期后行标准胃癌根治术,常规手术组行标准胃癌根治术。观察化疗+手术组的临床缓解程度、化疗的不良反应、CT缓解程度、病理反应程度。比较2组间R0切除率及生存期的差异。评价CT缓解程度与病理反应程度关系,及二者与生存期之间的关系。结果化疗+手术组化疗后的不良反应以恶心、呕吐为主,未出现Ⅲ、Ⅳ级不良反应。化疗+手术组CT缓解总有效率为60.0%,肿瘤控制率为90.0%。其中有20例获得临床降期,降期率达到33.3%。病理反应分级中有效组有11例(18.33%),无效组49例(81.7%)。CT缓解程度与病理反应程度呈负相关性(r=-0.391,P=0.002)。化疗+手术组的R0切除率为86.6%,常规手术组R0切除率为78.3%,二者有统计学差异(P=0.022)。2组间生存曲线比较无差异,但对Ⅲc期患者生存期进行分层分析发现,化疗+手术组生存期高于常规手术组,二者有统计学差异(P=0.042)。CT缓解组与未缓解组生存期差异有统计学意义(P=0.035),但病理有效组与无效组生存期比较差异无统计学意义(P=0.816)。结论术前化疗能够提高进展期胃癌患者R0手术切除率,影响Ⅲe期患者的生存期,而且是安全可靠的。CT缓解程度可以作为判断化疗有效程度及预后的参考指标。

Objective To investigate the CT regression degree and pathological reaction, and their relationship with survival rate after neoadjuvant chemotherapy for advanced gastric cancer.Methods One hundred and twenty patients with ad-vanced gastric carcinoma were enrolled, they were divided into chemotherapy ＋operation group and routine operation group, chemotherapy ＋operation group received FOLFOX-7 regimen chemotherapy for 2 cycles, then standard gastric cancer radical operation was performed, routine operation group underwent standard radical resection of gastric cancer.Observing the clinical regression degree, adverse reactions of chemotherapy, CT regression degree, pathological reaction degree in the chemotherapy plus operation group.Compare the R0 resection rate and survival differences between the 2 groups.Evaluate the relationship between CT relieve degree and pathological reaction degree, and the relationship between them and the survival period.Results The adverse reaction of chemotherapy combined with operation group were nausea and vomiting, without the level III, IV adverse reaction.Chemotherapy plus surgery group’ s CT relieve rate was 60.0%;the tumor control rate was 90.0%.20 ca-ses showed clinical down-staging, down-staging rate reached 33.3%.Pathological response revealed that effective group of 11 cases （18.3%）, invalid group of 49 cases （81.7%）.CT relieve degree was negative correlated with the pathological reac-tion degree （ r =-0.391, P =0.002）.Chemotherapy plus surgery group’ s R0 resection rate was 86.6%, the surgery group’s R0 resection rate was 78.3%, which showed significant difference （ P =0.022）.No differences of the survival curve between the 2 groups, but stratified analysis of stage IIIc patients’ survival period showed that chemotherapy ＋surgery group’s survival period were higher than that of the surgery group, there was significant different （ P =0.042）.CT relieve＆amp;nbsp;group and no relieve group had a statistically significant differences of the survival period （ P =0.035）, but the pathological effective group and ineffective group’s survival period did not reveal statistical significance different （ P =0.816）.Conclu-sion The preoperative chemotherapy can improve the R0 resection rate in patients with progressive stage gastric cancer, in-fluence the stage IIIc patient’s survival period, and is safe and reliable.CT regression degree can be used as a reference in-dex for judging the degree of effective chemotherapy and prognosis.