新辅助免疫治疗联合化疗对进展期胃癌及食管胃结合部腺癌围手术期的影响

Perioperative efficacies of neoadjuvant chemotherapy for advanced gastric cancer and gastroesophageal junction adenocarcinoma

目的探讨进展期胃癌及食管胃结合部腺癌病人进行的新辅助免疫治疗联合化疗对围手术期安全性以及有效性的影响。方法采用回顾性研究方法,收集2021年1月至2024年1月期间于华中科技大学同济医学院附属同济医院胃肠外科中心接受新辅助治疗并进行手术的病人临床资料,并排除术前接受放疗病人。共88例病人纳入研究,根据术前治疗方案的不同,分为单纯化疗组(55例)和免疫联合化疗组(33例)。两组病人的术前临床病理特征比较无统计学差别。主要观察指标为两组围手术期指标:手术时间,术中估计出血量、肿瘤R0切除率、淋巴结清扫数目、术后首次肛门排气时间、术后住院时间、住院总费用、总体并发症发生率以及严重并发症发生率。次要指标为胃原发灶肿瘤退缩分级(tumor regression grade,TRG)。结果与单纯化疗组相比,免疫联合化疗组手术时间、术中出血量、肿瘤R0切除率、淋巴结清扫数目、术后首次肛门排气时间、手术单次住院费用、术后住院时间均无统计学差别。和单纯化疗组比较,免疫联合化疗组术后总体并发症发生率稍高,但无统计学意义(P>0.05)。在严重并发症发生率方面,两组发生率均极低,并且无统计学差异(P>0.05)。与单纯化疗相比较,免疫联合化疗组完全缓解+部分缓解比例更高,并且具有统计学差异(P<0.05)。对两组术后病理原发灶TRG进行比较,免疫联合化疗组TRG 0级以及1级比例更高,并且具有统计学意义(P<0.05)。结论术前免疫治疗联合化疗不增加围手术期手术风险,且能取得更好的短期临床疗效,长期疗效有待进一步观察研究。

Objective To explore the effect of neoadjuvant chemotherapy or immunochemotherapy on perioperative safety and efficacy in patients with advanced gastric cancer(GC)and adenocarcinoma of gastroesophageal junction.Methods From January 2021 to January 2024,retrospective review was performed for the relevant clinical data of 88 patients undergoing neoadjuvant therapy and surgery.Individuals on preoperative radiotherapy were excluded.Based upon different preoperative medication regimens,they were assigned into two groups of neoadjuvant chemotherapy alone(n=55)and preoperative immunochemotherapy(n=33).No statistically significant inter-group differences existed in clinicopathological characteristics.The major outcome measures included operative duration,volume of blood loss,R0 resection rate,dissected lymph node number,time to an initial anal exhaust,length of postoperative hospitalization stay,total hospitalization expense and the incidence of postoperative overall and severe complications.Secondary outcome measure was tumor regression grade(TRG)of primary gastric lesion.Results No statistically significant inter-group differences existed in operative duration,volume of blood loss,R0 resection rate,number of lymph node dissections,time to an initial anal exhaust,total hospitalization expense or length of postoperative stay.The overall incidence of postoperative complications was slightly higher in combination immunotherapy group.There was no statistically significant difference(P>0.05).Both groups exhibited remarkably low rates of severe complications.There was no statistically significant difference(P>0.05).As compared with neoadjuvant chemotherapy alone group,preoperative immunochemotherapy group had a significantly higher proportion of complete/partial remission(P<0.05).And the proportion of TRG grade 0/1 was significantly higher in preoperative immunochemotherapy group(P<0.05).Conclusion Preoperative immunochemotherapy does not elevate perioperative surgical risks and may achieve better short-term outcomes.Further studies are required for evaluating possible long-term outcomes.