Abstract：
BACKGROUND: Although surgery remains the cornerstone of gastric cancer therapy, the use of radiation therapy (RT) is increasingly being employed to optimize outcomes. We sought to assess outcomes following use of RT for the treatment of gastric adenocarcinoma.
METHODS: Using the National Cancer Data Base (NCDB) from 1998 to 2012, all patients with resected gastric adenocarcinoma were identified. Patients were stratified into four groups based on preoperative therapy: RT alone, chemotherapy only, chemoradiotherapy (CRT), and no preoperative therapy. Overall survival was estimated using multivariate Cox proportional hazards model. Adjusted secondary outcomes include margin positivity, lymph node harvest, LOS, 30-day readmission and mortality.
RESULTS: A total of 10 019 patients met study criteria. In the unadjusted analysis, patients undergoing CRT compared to chemotherapy alone had fewer positive margins (7.9% vs 15.9%; P < 0.001), increased negative LNs (54.6% vs 37.7%; P < 0.001) with reduced LN retrieval (mean: 13.5 vs 19.6; P < 0.01). After multivariate adjustment, there was no survival benefit to any preoperative therapy; however, preoperative RT/CRT remained associated with decreased LN retrieval.
CONCLUSIONS: The results support previous reports on preoperative RT resulting in decreased margin positivity. This study highlights the need to reconsider practice guidelines regarding appropriate lymphadenectomy in the setting of preoperative RT given reduced LN retrieval.
METHODS: Using the National Cancer Data Base (NCDB) from 1998 to 2012, all patients with resected gastric adenocarcinoma were identified. Patients were stratified into four groups based on preoperative therapy: RT alone, chemotherapy only, chemoradiotherapy (CRT), and no preoperative therapy. Overall survival was estimated using multivariate Cox proportional hazards model. Adjusted secondary outcomes include margin positivity, lymph node harvest, LOS, 30-day readmission and mortality.
RESULTS: A total of 10 019 patients met study criteria. In the unadjusted analysis, patients undergoing CRT compared to chemotherapy alone had fewer positive margins (7.9% vs 15.9%; P < 0.001), increased negative LNs (54.6% vs 37.7%; P < 0.001) with reduced LN retrieval (mean: 13.5 vs 19.6; P < 0.01). After multivariate adjustment, there was no survival benefit to any preoperative therapy; however, preoperative RT/CRT remained associated with decreased LN retrieval.
CONCLUSIONS: The results support previous reports on preoperative RT resulting in decreased margin positivity. This study highlights the need to reconsider practice guidelines regarding appropriate lymphadenectomy in the setting of preoperative RT given reduced LN retrieval.
摘要：
背景：尽管手术仍是胃癌治疗的基石，放射治疗(RT)的使用越来越多地用于优化结局.我们试图评估使用RT治疗胃腺癌后的结果。
方法：使用1998年至2012年的国家癌症数据库（NCDB），确定所有切除的胃腺癌患者。根据术前治疗将患者分为四组：仅RT，只有化疗,放化疗（CRT），也没有术前治疗.使用多变量Cox比例风险模型估计总生存期。调整后的次要结果包括边缘阳性，淋巴结收获，LOS,30天再入院和死亡率。
结果：共10019例患者符合研究标准。在未经调整的分析中，与单纯化疗相比，接受CRT的患者的阳性切缘较少（7.9％vs15.9％；P<0.001），阴性LN增加（54.6％vs37.7％；P<0.001），LN恢复减少（平均值：13.5vs19.6；P<0.01）。经过多变量调整后，任何术前治疗都没有生存益处；然而，术前RT/CRT仍与LN恢复减少相关.
结论：结果支持先前关于术前RT导致边缘阳性降低的报告。这项研究强调了在减少LN检索的术前RT设置中重新考虑有关适当淋巴结清扫的实践指南的必要性。
方法：使用1998年至2012年的国家癌症数据库（NCDB），确定所有切除的胃腺癌患者。根据术前治疗将患者分为四组：仅RT，只有化疗,放化疗（CRT），也没有术前治疗.使用多变量Cox比例风险模型估计总生存期。调整后的次要结果包括边缘阳性，淋巴结收获，LOS,30天再入院和死亡率。
结果：共10019例患者符合研究标准。在未经调整的分析中，与单纯化疗相比，接受CRT的患者的阳性切缘较少（7.9％vs15.9％；P<0.001），阴性LN增加（54.6％vs37.7％；P<0.001），LN恢复减少（平均值：13.5vs19.6；P<0.01）。经过多变量调整后，任何术前治疗都没有生存益处；然而，术前RT/CRT仍与LN恢复减少相关.
结论：结果支持先前关于术前RT导致边缘阳性降低的报告。这项研究强调了在减少LN检索的术前RT设置中重新考虑有关适当淋巴结清扫的实践指南的必要性。
