PDF(Pubmed)
Abstract：
BACKGROUND: Despite the preference for multimodal treatment for gastric cancer, abandonment of chemotherapy treatment as well as the need for upfront surgery in obstructed patients brings negative impacts on the treatment. The difficulty of accessing treatment in specialized centers in the Brazilian Unified National Health System (SUS) scenario is an aggravating factor.
OBJECTIVE: To identify advantages, prognostic factors, complications, and neoadjuvant and adjuvant therapies survival in gastric cancer treatment in SUS setting.
METHODS: The retrospective study included 81 patients with gastric adenocarcinoma who underwent treatment according to INT0116 trial (adjuvant chemoradiotherapy), CLASSIC trial (adjuvant chemotherapy), FLOT4-AIO trial (perioperative chemotherapy), and surgery with curative intention (R0 resection and D2 lymphadenectomy) in a single cancer center between 2015 and 2020. Individuals with other histological types, gastric stump, esophageal cancer, other treatment protocols, and stage Ia or IV were excluded.
RESULTS: Patients were grouped into FLOT4-AIO (26 patients), CLASSIC (25 patients), and INT0116 (30 patients). The average age was 61 years old. More than 60% of patients had pathological stage III. The treatment completion rate was 56%. The pathological complete response rate of the FLOT4-AIO group was 7.7%. Among the prognostic factors that impacted overall survival and disease-free survival were alcoholism, early postoperative complications, and anatomopathological status pN2 and pN3. The 3-year overall survival rate was 64.9%, with the CLASSIC subgroup having the best survival (79.8%).
CONCLUSIONS: The treatment strategy for gastric cancer varies according to the need for initial surgery. The CLASSIC subgroup had better overall survival and disease-free survival. The INT0116 regimen also protected against mortality, but not with statistical significance. Although FLOT4-AIO is the preferred treatment, the difficulty in carrying out neoadjuvant treatment in SUS scenario had a negative impact on the results due to the criticality of food intake and worse treatment tolerance.
OBJECTIVE: To identify advantages, prognostic factors, complications, and neoadjuvant and adjuvant therapies survival in gastric cancer treatment in SUS setting.
METHODS: The retrospective study included 81 patients with gastric adenocarcinoma who underwent treatment according to INT0116 trial (adjuvant chemoradiotherapy), CLASSIC trial (adjuvant chemotherapy), FLOT4-AIO trial (perioperative chemotherapy), and surgery with curative intention (R0 resection and D2 lymphadenectomy) in a single cancer center between 2015 and 2020. Individuals with other histological types, gastric stump, esophageal cancer, other treatment protocols, and stage Ia or IV were excluded.
RESULTS: Patients were grouped into FLOT4-AIO (26 patients), CLASSIC (25 patients), and INT0116 (30 patients). The average age was 61 years old. More than 60% of patients had pathological stage III. The treatment completion rate was 56%. The pathological complete response rate of the FLOT4-AIO group was 7.7%. Among the prognostic factors that impacted overall survival and disease-free survival were alcoholism, early postoperative complications, and anatomopathological status pN2 and pN3. The 3-year overall survival rate was 64.9%, with the CLASSIC subgroup having the best survival (79.8%).
CONCLUSIONS: The treatment strategy for gastric cancer varies according to the need for initial surgery. The CLASSIC subgroup had better overall survival and disease-free survival. The INT0116 regimen also protected against mortality, but not with statistical significance. Although FLOT4-AIO is the preferred treatment, the difficulty in carrying out neoadjuvant treatment in SUS scenario had a negative impact on the results due to the criticality of food intake and worse treatment tolerance.
摘要：
背景：尽管胃癌的多模式治疗具有优势，放弃化疗治疗以及对阻塞患者进行前期手术的需要对治疗产生负面影响。在巴西统一国家卫生系统（SUS）方案中，在专门中心获得治疗的困难是一个加重因素。
目标：为了确定优势，预后因素，并发症,在SUS环境中胃癌治疗的新辅助和辅助治疗生存率。
方法：回顾性研究包括81例胃腺癌患者，这些患者根据INT0116试验（辅助放化疗）接受了治疗，经典试验（辅助化疗），FLOT4-AIO试验（围手术期化疗），以及2015年至2020年在单个癌症中心进行的治愈意向手术（R0切除和D2淋巴结清扫术）。具有其他组织学类型的个体，胃残端,食道癌,其他治疗方案,并排除Ia或IV期。
结果：患者分为FLOT4-AIO（26例），经典（25名患者），INT0116（30名患者）。平均年龄为61岁。60%以上的患者有病理III期。治疗完成率为56%。FLOT4-AIO组病理完全缓解率为7.7%。影响总体生存率和无病生存率的预后因素包括酒精中毒，术后早期并发症,和解剖病理学状态pN2和pN3。3年总生存率为64.9%,CLASSIC亚组生存率最好(79.8%)。
结论：胃癌的治疗策略因初次手术的需要而异。CLASSIC亚组具有更好的总生存率和无病生存率。INT0116方案还可以预防死亡率，但没有统计学意义。尽管FLOT4-AIO是首选治疗方法，在SUS方案中进行新辅助治疗的困难对结果有负面影响,因为食物摄入的重要性和治疗耐受性较差.
目标：为了确定优势，预后因素，并发症,在SUS环境中胃癌治疗的新辅助和辅助治疗生存率。
方法：回顾性研究包括81例胃腺癌患者，这些患者根据INT0116试验（辅助放化疗）接受了治疗，经典试验（辅助化疗），FLOT4-AIO试验（围手术期化疗），以及2015年至2020年在单个癌症中心进行的治愈意向手术（R0切除和D2淋巴结清扫术）。具有其他组织学类型的个体，胃残端,食道癌,其他治疗方案,并排除Ia或IV期。
结果：患者分为FLOT4-AIO（26例），经典（25名患者），INT0116（30名患者）。平均年龄为61岁。60%以上的患者有病理III期。治疗完成率为56%。FLOT4-AIO组病理完全缓解率为7.7%。影响总体生存率和无病生存率的预后因素包括酒精中毒，术后早期并发症,和解剖病理学状态pN2和pN3。3年总生存率为64.9%,CLASSIC亚组生存率最好(79.8%)。
结论：胃癌的治疗策略因初次手术的需要而异。CLASSIC亚组具有更好的总生存率和无病生存率。INT0116方案还可以预防死亡率，但没有统计学意义。尽管FLOT4-AIO是首选治疗方法，在SUS方案中进行新辅助治疗的困难对结果有负面影响,因为食物摄入的重要性和治疗耐受性较差.
