可切除胃癌综合治疗模式变化分析

Changes of multimodality therapeutic patterns of care study for resectable gastric cancer

目的调查分析可切除胃癌综合治疗模式的现状,为进一步优化胃癌综合治疗策略提供参考。方法回顾性分析在苏州大学附属第二医院接受手术并具有完整治疗资料的265例可切除胃癌患者。详细记录患者临床特征、术前检查、病理结果、手术和围术期治疗情况以及疗效。分析诊治过程与规范指南的差距,了解胃癌综合模式的变化趋势。结果 2008年(早年组)和2013年(近年组)在我院行胃癌根治术的患者分别为127例和138例,其中行D2根治术的比例分别为52.8%和60.1%(P<0.01),淋巴结清扫数目≥15个为5.5%和52.8%(P<0.01),中位淋巴结清扫数目由6个提高到16个,两组接受新辅助化疗患者分别为2.4%和3.6%(P=0.55)。早年组中接受单纯术后化疗和术后辅助放化疗比例分别为62.2%和2.4%,近年组中的分别为58.0%和8.0%(P=0.04)。此外,术后化疗早年组79例(62.2%),近年组80例(58.0%)(P=0.48)。结论胃癌根治术水平不断提高,治疗逐步规范,但距离日韩等标准的D2根治术还存在差距;术后辅助放疗在内的辅助治疗可使患者获益,但仍有部分应接受辅助治疗的患者未接受治疗,胃癌的综合治疗还需进一步加强。

Objective To investigate and analyze the current status of multimodality therapy for resectable gastric cancer,aiming to provide reference for optimizing the multimodality treatment strategy for gastric cancer.Methods Clinical data of patients diagnosed with gastric adenocarcinoma undergoing radical gastrectomy in the Second Affiliated Hospital of Soochow University were retrospectively analyzed.Clinical characteristics,preoperative medical comorbidities,pathological features,surgical and perioperative status and clinical efficacy were recorded.The gap between the diagnosis and treatment procedures and the standard guidelines was analyzed.The changes in the multimodality treatment patterns for gastric cancer were understood.Results A total of 265 patients were included in this study.All patients were divided into two cohorts:early[2008]and late[2013]cohorts.In the early cohort,127 patients were assigned,and 138 cases in the late cohort.In the early cohort,67 patients(52.8%)underwent D2 lymph node dissection,significantly less than 83 patients(60.1%)in the late cohort(P<0.01).In the early and late cohorts,the proportion of patients with the number of lymph node dissection of≥15 was 5.5%and 52.8%(P<0.01).The median number of lymph node dissection was increased from 6 to 16.The proportion of patients receiving neoadjuvant chemotherapy in the early and late cohorts was 2.4%and 3.6%(P=0.55).In the early cohort,the proportion of patients treated with postoperative chemotherapy and postoperative adjuvant chemoradiotherapy was 62.6%and 2.4%,significantly higher compared with 58.0%and 8.0%in the late cohort(P=0.04).In addition,the proportion of patients receiving postoperative chemotherapy in the early cohort was 62.2%(n=79)and 58.0%(n=80)in the late cohort(P=0.48).Conclusions Although the level of radical gastrectomy has been continuously improved and standardized in China,which still lags behind the standard D2 radical gastrectomy in Japan and South Korea.Adjuvant therapies including postoperative adjuvant radiotherapy can bring clinical benefits.However,the proportion of patients receiving adjuvant therapy is still low,and the multimodality therapy of gastric cancer should be widely applied.