背景：晚期胃癌是一种常见的恶性肿瘤，通常诊断为晚期，在根治性手术治疗后仍有复发的风险。放化疗,作为胃癌的重要治疗方法之一,对于提高患者的生存率具有重要意义。然而,胃癌患者放化疗后的肿瘤复发和生存预后仍不确定。
目的：分析进展期胃癌根治性放化疗后肿瘤复发情况，为临床医生提供更深入的指导。
方法：回顾性分析2021-2023年在我院接受术后辅助放化疗的171例胃癌患者的临床资料。采用Kaplan-Meier法计算复发率和生存率;采用log-rank法进行单因素预后分析;采用Cox模型进行多因素预后分析。
结果：全组中位随访时间为63个月，随访率为93.6%。Ⅱ期和Ⅲ期患者分别占31.0%和66.7%,分别。3级及以上急性胃肠道反应和血液学不良反应发生率分别为8.8%和9.9%。分别。共有166名患者完成了整个放化疗方案,期间无不良反应相关死亡发生.就复发模式而言，17例患者局部复发，29例患者有远处转移，12例患者发生腹膜种植转移。1年,3年,5年总生存率（OS）为83.7%，66.3%,和60.0%，分别。1年,3年,5年无病生存率为75.5%,62.7%,56.5%,分别。多变量分析表明，T分期，周围神经侵犯,淋巴结转移率（LNR）是OS的独立预后因素。
结论：胃癌术后调强放疗联合化疗治疗耐受性好，不良反应可接受。有利于肿瘤局部控制,提高患者的长期生存率。LNR是OS的独立预后因素。对于局部复发风险高的患者，应考虑术后辅助放化疗.
BACKGROUND: Advanced gastric cancer is a common malignancy that is often diagnosed at an advanced stage and is still at risk of recurrence after radical surgical treatment. Chemoradiotherapy, as one of the important treatment methods for gastric cancer, is of great significance for improving the survival rate of patients. However, the tumor recurrence and survival prognosis of gastric cancer patients after radiotherapy and chemotherapy are still uncertain.
OBJECTIVE: To analyze the tumor recurrence after radical radiotherapy and chemotherapy for advanced gastric cancer and provide more in-depth guidance for clinicians.
METHODS: A retrospective analysis was performed on 171 patients with gastric cancer who received postoperative adjuvant radiotherapy and chemotherapy in our hospital from 2021 to 2023. The Kaplan-Meier method was used to calculate the recurrence rate and survival rate; the log-rank method was used to analyze the single-factor prognosis; and the Cox model was used to analyze the prognosis associated with multiple factors.
RESULTS: The median follow-up time of the whole group was 63 months, and the follow-up rate was 93.6%. Stage II and III patients accounted for 31.0% and 66.7%, respectively. The incidences of Grade 3 and above acute gastrointestinal reactions and hematological adverse reactions were 8.8% and 9.9%, respectively. A total of 166 patients completed the entire chemoradiotherapy regimen, during which no adverse reaction-related deaths occurred. In terms of the recurrence pattern, 17 patients had local recurrence, 29 patients had distant metastasis, and 12 patients had peritoneal implantation metastasis. The 1-year, 3-year, and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, respectively. The 1-year, 3-year, and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. Multivariate analysis revealed that T stage, peripheral nerve invasion, and the lymph node metastasis rate (LNR) were independent prognostic factors for OS.
CONCLUSIONS: Postoperative intensity-modulated radiotherapy combined with chemotherapy for gastric cancer treatment is well tolerated and has acceptable adverse effects, which is beneficial for local tumor control and can improve the long-term survival of patients. The LNR was an independent prognostic factor for OS. For patients with a high risk of local recurrence, postoperative adjuvant chemoradiation should be considered.
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