教科书式结局对新辅助化疗后行外科治疗的进展期胃癌患者的预后价值

Prognostic significance of textbook outcome in advanced gastric patients who underwent neoadjuvant chemotherapy followed by surgical resection

目的探讨新辅助化疗后行外科治疗的进展期胃癌患者教科书式结局(TO)的影响因素及预后价值。方法本研究为回顾性队列研究。回顾性分析2010年1月至2019年12月福建医科大学附属协和医院胃外科收治的253例新辅助化疗后行胃切除术联合D2淋巴结清扫的进展期胃癌患者的临床病理学资料,男性195例,女性58例,年龄(60.3±10.0)岁(范围:27~75岁)。根据术后是否达到TO分为TO组(168例)和非TO组(85例)。采用多因素Logistic回归分析TO的独立影响因素。采用Cox回归模型分析总体生存和无病生存的独立预后因素。将TO组和非TO组按1∶1行倾向性评分匹配,对匹配后的资料用Kaplan-Meier法行生存分析。结果253例进展期胃癌患者中,达到TO的比例为66.4%(168/253)。多因素Logistic回归结果显示,美国东部肿瘤协作组评分(OR=0.488,95%CI:0.278~0.856,P=0.012)和ypN分期(OR=0.626,95%CI:0.488~0.805,P<0.01)是TO的独立影响因素。多因素Cox回归结果显示,TO是总体生存(HR=0.662,95%CI:0.457~0.959,P=0.029)和无病生存(HR=0.687,95%CI:0.483~0.976,P=0.036)的独立预后因素。倾向性评分匹配后,TO组的5年总体生存率(42.2%比27.8%)、5年无病生存率(37.5%比27.8%)均高于非TO组(P值均<0.05)。非TO组患者接受术后化疗后其总体生存和无病生存明显改善(P值均<0.05),而TO组患者接受术后化疗后其总体生存和无病生存无明显改善(P值均>0.05)。结论TO是新辅助化疗后行外科治疗的进展期胃癌患者术后生存的独立预后因素,并且与术后化疗获益相关,可根据患者是否达到TO制定个体化治疗方案。

Objective To investigate the risk factors and prognostic value of the textbook outcome(TO)in patients with advanced gastric cancer(AGC)who underwent neoadjuvant chemotherapy followed by surgical resection.Methods This is a retrospective cohort study.A total of 253 patients with AGC who underwent neoadjuvant chemotherapy combined with gastrectomy and D2 lymphadenectomy in the Department of Gastric Surgery,Fujian Medical University Union Hospital from January 2010 to December 2019 were retrospectively included.There were 195 males and 58 females,aged(60.3±10.0)years(range:27 to 75 years).The patients were then divided into the TO group(n=168)and the non-TO group(n=85).Multivariate Logistic regression was used to analyze the independent predictors of TO.Univariate and multivariate Cox analysis were used to analyze independent prognosis factors for overall survival(OS)and disease-free survival(DFS).Propensity score matching was performed to balance the TO and non-TO groups,and the Kaplan-Meier method was used to calculate survival rates and draw survival curves.Results Among the 253 patients,168 patients(66.4%)achieved TO.The Eastern Cooperative Oncology Group score(OR=0.488,95%CI:0.278 to 0.856,P=0.012)and ypN stage(OR=0.626,95%CI:0.488 to 0.805,P<0.01)were independently predictive of TO.Multivariate analysis revealed that TO was an independent risk factor for both OS(HR=0.662,95%CI:0.457 to 0.959,P=0.029)and DFS(HR=0.687,95%CI:0.483 to 0.976,P=0.036).After matching,the 5-year OS rate(42.2%vs.27.8%)and the 5-year DFS rate(37.5%vs.27.8%)were significantly higher in the TO group than in the non-TO group(both P<0.05).Furthermore,patients in the non-TO group benefited significantly from postoperative chemotherapy(both P<0.05),but those in the TO group did not(both P>0.05).Conclusion TO is an independent prognosis factor in patients undergoing neoadjuvant chemotherapy and surgery for AGC and is associated with postoperative chemotherapy benefits.