PDF(Pubmed)
Abstract：
UNASSIGNED: There is a lack of evidence on whether resectable locally advanced gastric cancer (LAGC) patients could benefit from neoadjuvant or adjuvant radiotherapy (RT).
UNASSIGNED: Patients with surgically diagnosed LAGC from 2004 to 2015 were retrieved from the SEER database. Kaplan-Meier method and the log-rank test were used to evaluate survival analysis between neoadjuvant and adjuvant RT. Univariate Cox regression was used to evaluate the hazard ratio (HR) and 95 % confidence interval (CI).
UNASSIGNED: A total of 4790 LAGC patients who treated with surgery and RT were identified, including 3187 patients with intestinal subtype and 1603 patients with diffuse subtype. For patients with both intestinal and diffuse subtypes, median cancer-specific survival (mCSS) was better with adjuvant RT or neoadjuvant RT. Moreover, patients benefited more from adjuvant RT than neoadjuvant RT (intestinal subtype: mCSS 49 vs. 36 months, P < 0.001; diffuse subtype: mCSS 32 vs. 26 months, P = 0.050). Further analyses showed that patients with intestinal subtype and T1-2N+, T3N-, T3N+ subgroups, as well as patients with diffuse subtype and T1-2N+ and T3N+ subgroups benefited more from adjuvant RT than those with neoadjuvant RT. Patients in the diffuse subtype and T3N- subgroups also tended benifit from adjuvant RT and survive. There was no difference in survival between the T4N- and T4N + subgroups of the two subtypes. After propensity score matching, subgroup analysis identified an improved survival in favor of adjuvant RT in the age ≥65 years and female subgroups in diffuse subtypes and T4N+ patients.
UNASSIGNED: For patients with resectable LAGC in the T1-2N+, T3N-, T3N+ clinical subgroups, adjuvant RT yields more benefits than neoadjuvant RT or no RT, which is worthy of prospective clinical trial.
UNASSIGNED: Patients with surgically diagnosed LAGC from 2004 to 2015 were retrieved from the SEER database. Kaplan-Meier method and the log-rank test were used to evaluate survival analysis between neoadjuvant and adjuvant RT. Univariate Cox regression was used to evaluate the hazard ratio (HR) and 95 % confidence interval (CI).
UNASSIGNED: A total of 4790 LAGC patients who treated with surgery and RT were identified, including 3187 patients with intestinal subtype and 1603 patients with diffuse subtype. For patients with both intestinal and diffuse subtypes, median cancer-specific survival (mCSS) was better with adjuvant RT or neoadjuvant RT. Moreover, patients benefited more from adjuvant RT than neoadjuvant RT (intestinal subtype: mCSS 49 vs. 36 months, P < 0.001; diffuse subtype: mCSS 32 vs. 26 months, P = 0.050). Further analyses showed that patients with intestinal subtype and T1-2N+, T3N-, T3N+ subgroups, as well as patients with diffuse subtype and T1-2N+ and T3N+ subgroups benefited more from adjuvant RT than those with neoadjuvant RT. Patients in the diffuse subtype and T3N- subgroups also tended benifit from adjuvant RT and survive. There was no difference in survival between the T4N- and T4N + subgroups of the two subtypes. After propensity score matching, subgroup analysis identified an improved survival in favor of adjuvant RT in the age ≥65 years and female subgroups in diffuse subtypes and T4N+ patients.
UNASSIGNED: For patients with resectable LAGC in the T1-2N+, T3N-, T3N+ clinical subgroups, adjuvant RT yields more benefits than neoadjuvant RT or no RT, which is worthy of prospective clinical trial.
摘要：
■缺乏关于可切除的局部晚期胃癌（LAGC）患者是否可以从新辅助或辅助放疗（RT）中受益的证据。
■从SEER数据库检索2004年至2015年手术诊断的LAGC患者。采用Kaplan-Meier法和log-rank检验评价新辅助和辅助RT的生存分析。单因素Cox回归用于评估风险比（HR）和95％置信区间（CI）。
■共有4790名接受手术和RT治疗的LAGC患者被确认，其中肠道亚型3187例,弥漫性亚型1603例。对于肠道和弥漫性亚型的患者，辅助RT或新辅助RT的中位癌症特异性生存期(mCSS)更好.此外，患者从辅助RT比新辅助RT获益更多(肠道亚型：mCSS49vs.36个月,P<0.001；弥漫性亚型：mCSS32vs.26个月,P=0.050)。进一步的分析表明，肠道亚型和T1-2N+的患者，T3N-,T3N+子组，以及弥漫性亚型和T1-2N+和T3N+亚组的患者从辅助RT获益比新辅助RT获益更多。弥漫性亚型和T3N亚组的患者也倾向于从辅助RT获益并存活。两种亚型的T4N-和T4N+亚组之间的存活没有差异。在倾向得分匹配后，亚组分析发现,在年龄≥65岁的患者中,在弥漫性亚型和T4N+患者中,女性亚组的生存率提高,有利于辅助RT治疗.
■对于T1-2N+的可切除LAGC患者，T3N-,T3N+临床亚组，辅助RT比新辅助RT或无RT产生更多的益处，值得进行前瞻性临床试验。
■从SEER数据库检索2004年至2015年手术诊断的LAGC患者。采用Kaplan-Meier法和log-rank检验评价新辅助和辅助RT的生存分析。单因素Cox回归用于评估风险比（HR）和95％置信区间（CI）。
■共有4790名接受手术和RT治疗的LAGC患者被确认，其中肠道亚型3187例,弥漫性亚型1603例。对于肠道和弥漫性亚型的患者，辅助RT或新辅助RT的中位癌症特异性生存期(mCSS)更好.此外，患者从辅助RT比新辅助RT获益更多(肠道亚型：mCSS49vs.36个月,P<0.001；弥漫性亚型：mCSS32vs.26个月,P=0.050)。进一步的分析表明，肠道亚型和T1-2N+的患者，T3N-,T3N+子组，以及弥漫性亚型和T1-2N+和T3N+亚组的患者从辅助RT获益比新辅助RT获益更多。弥漫性亚型和T3N亚组的患者也倾向于从辅助RT获益并存活。两种亚型的T4N-和T4N+亚组之间的存活没有差异。在倾向得分匹配后，亚组分析发现,在年龄≥65岁的患者中,在弥漫性亚型和T4N+患者中,女性亚组的生存率提高,有利于辅助RT治疗.
■对于T1-2N+的可切除LAGC患者，T3N-,T3N+临床亚组，辅助RT比新辅助RT或无RT产生更多的益处，值得进行前瞻性临床试验。
