局部进展期胃癌D2根治术R0切除患者术后放化疗与术后化疗长期生存和复发对比:10年随访回顾性分析

Comparison of Clinical Efficacy and Recurrence Between Adjuvant Chemoradiotherapy and Chemotherapy after D2 Lymphadenectomy and R0 Resection for Locally Advanced Gastric Cancer:A Retrospective Survival Analysis of 10-year Follow-Up

[目的]对比分析经D2根治术后R0切除的局部进展期胃癌患者术后放化疗和术后化疗的生存及复发差异,探讨术后放化疗价值。[方法]收集并随访行D2根治术后分别行术后放化疗和术后化疗共222例局部进展期胃癌患者资料,对比分析两组生存和复发情况。[结果]术后放化疗组和术后化疗组中位生存时间分别为37.10个月和38.35个月,差异无统计学意义(P>0.05);术后放化疗组局部复发率为28.95%,低于术后化疗组的44.44%(P<0.05)。多因素分析显示T分期(HR=2.049,95%CI:1.419~2.957,P<0.001)、N分期(HR=2.308,95%CI:1.498~3.555,P<0.001)是独立预后因素。亚组分析显示,两组N2期患者中位生存时间分别为49.20个月和37.30个月,5年及10年生存率术后放化疗组高于术后化疗组,差异有统计学意义(P<0.05)。[结论]局部进展期胃癌患者术后放化疗生存情况不优于术后化疗;术后放化疗局部控制优于术后化疗;N2期患者术后放化疗生存情况可能优于术后化疗。

[Objective]To compared the survival and recurrence differences between postoperative chemoradiotherapy(RCT)and chemotherapy alone(CT)in patients with locally advanced gastric cancer who underwent D2 radical resection followed by R0 resection.[Methods]The clinical data of 222 patients with locally advanced gastric cancer,who underwent postoperative chemoradiotherapy(RCT)or chemotherapy alone(CT group)after D2 radical resection were collected.All patients were followed up for 10 years,the survival and recurrence were compared and analyzed.[Results]The median overall survival(mOS)was 37.10 months and 38.35 months in RCT group and CT group(P>0.05),respectively.The local recurrence rate in RCT group was lower than that in CT group(28.95%vs 44.44%,P<0.05).Multivariate analysis showed that T stage(HR=2.049,95%CI:1.419~2.957,P<0.001)and N stage(HR=2.308,95%CI:1.498~3.555,P<0.001)were independent prognostic factors for OS.Subgroup analysis showed that for N2 patients the median survival of two groups was 49.20 months and 37.30 months;and the 5-year and 10-year survival in RCT group were higher than those in CT group(P<0.05).[Conclusion]Overall,the survival of chemoradiotherapy for patients with locally advanced gastric cancer is not better than that of chemotherapy alone;but the local control of chemoradiotherapy group is better.Postoperative chemoradiotherapy may be superior to postoperative chemotherapy in N2 patients.