术前和术后同步放化疗在Ⅲ-Ⅳ_(A)期胃癌的疗效及安全性比较

Comparison of efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies for stageⅢ-Ⅳ_(A) gastric cancer

目的比较术前和术后同步放化疗在接受D2根治术的Ⅲ-Ⅳ_(A)期胃癌患者的疗效及安全性。方法回顾性分析2012年至2019年在郑州大学附属肿瘤医院接受D2根治术R0切除的47例Ⅲ-Ⅳ_(A)期胃癌患者临床资料,放疗剂量为45~50.4 Gy/1.8~2.0 Gy/25~28次/5~6周,比较接受术前同步放化疗(A组,25例)和术后同步放化疗(B组,22例)患者的无病生存期(DFS)、总生存期(OS)、局部复发率、远处转移率和不良反应。结果两组患者临床基线特征差异无统计学意义。中位随访时间48个月(3~72个月)。A组1年OS显著优于B组,差异有统计学意义(92%vs.54.5%,χ^(2)=5.68,P=0.017);3年OS和DFS分别为56%vs.40.9%(P>0.05)和51.4%vs.31.8%(P>0.05),差异无统计学意义。两组患者局部复发率相当,差异无统计学意义(P>0.05),A组远处转移率低于B组,差异有统计学意义(χ^(2)=6.01,P=0.014)。两组消化道不良反应和骨髓抑制的差异无统计学意义(P>0.05)。结论对于D2根治术后Ⅲ-Ⅳ_(A)期的胃癌患者,术前和术后同步放化疗疗效及安全性相当,且术前放化疗的1年总生存率和远处转移率优于术后放化疗。

Objective To compare the efficacy and safety of preoperative and postoperative concurrent chemoradiotherapies in the treatment of stageⅢ-Ⅳ_(A) gastric cancer patients who underwent D2 lymphadenectomy with R0 resection.Methods A retrospective analysis was conducted on the clinical data of patients with stageⅢ-Ⅳ_(A) gastric cancer who underwent D2 lymphadenectomy with R0 resection in the Affiliated Cancer Hospital of Zhengzhou University from 2012 to 2019.Among these patients,25 received preoperative chemoradiotherapy(group A)and 22 received postoperative chemoradiotherapy(group B).The disease-free survival(DFS),overall survival(OS),local recurrence rate,distant metastasis rate,and adverse reactions were compared between both groups.The total dose,single dose,fractions,and duration of radiotherapy for all the patients were 45-50.4 Gy,1.8-2.0 Gy,25-28 fractions,and 5-6 weeks,respectively.The target areas were delineated in accordance with the ASTRO and EORTC-ROG guidelines.Results There was no statistical difference in clinical baseline characteristics between the two groups.The median follow-up was 48 months(3-72 months).The 1-year OS of group A was significantly higher than that of group B(92%vs.54.5%,χ^(2)=5.68,P=0.017).The 3-year OS and DFS of the two groups were 56%vs.40.9%(P>0.05)and 51.4%vs.31.8%(P>0.05),respectively.There was no significant difference in the local recurrence rate between both groups(P>0.05),but the distant metastasis rate of group A was significantly lower than that of group B(χ^(2)=6.01,P=0.014).There was no significant difference in digestive side effects and myelosuppression between both groups(P>0.05).Conclusions For patients with stageⅢ-Ⅳ_(A) gastric cancer after D2 lymphadenectomy with R0 resection,the preoperative and postoperative chemoradiotherapies yield similar efficacy and safety.However,compared to postoperative chemoradiotherapy,preoperative chemoradiotherapy improves the 1-year OS and reduces the distant metastasis rate.