背景:可切除的胃腺癌伴血管癌栓(RGAVCT)患者预后不良,5年生存率为18.42%-53.57%。这些患者需要合理的术后治疗方案以改善其预后。
目的:确定RGAVCT患者术后最有效的化疗方案。
方法:我们回顾性收集了2017年1月至2022年1月530例胃癌根治术患者的临床病理资料,这些患者经病理诊断为胃腺癌伴脉络膜癌栓。此外,我们通过评估符合纳入标准的患者的临床和病理特征,确定了可能影响RGAVCT患者预后的高危变量.我们还使用Mantel-Cox单变量和多变量分析评估了生存结果的重要性。I期患者的亚组,II,和III疾病谁接受单一-,dual-,使用SPSS25.0和R4.3.0中的ggplot2软件包分析了手术后的三联药物方案。
结果:总而言之,530名符合条件的RGAVCT患者纳入本研究。RGAVCT患者的中位总生存期(OS)为24个月,生存率为80.2%,62.5%,12个月、24个月和59个月为42.3%,分别。术前并发症,肿瘤大小,T级,根据Cox多变量分析模型,将术后化疗确定为影响RGAVCT患者OS的独立因素。Kaplan-Meier分析显示,化疗对I期或II期RGAVCT患者的OS无影响;然而,化疗对III期患者的OS有影响.接受由双药或三药方案组成的化疗的III期患者的生存率优于单药方案。并且在接受由双药或三药方案组成的化疗的患者的生存率方面没有观察到显著差异.
结论:对于III期RGAVCT患者,应推荐术后化疗的双药方案,而不是三药治疗,因为后者与不良事件的发生频率增加有关。
BACKGROUND: Patients with resectable gastric adenocarcinoma accompanied by vascular cancer thrombus (RGAVCT) have a poor prognosis, with a 5-year survival rate ranging from 18.42%-53.57%. These patients need a reasonable postoperative treatment plan to improve their prognosis.
OBJECTIVE: To determine the most effective postoperative chemotherapy regimen for patients with RGAVCT.
METHODS: We retrospectively collected the clinicopathological data of 530 patients who underwent radical resection for gastric cancer between January 2017 and January 2022 and who were pathologically diagnosed with gastric adenocarcinoma with a choroidal cancer embolus. Furthermore, we identified the high-risk variables that can influence the prognosis of patients with RGAVCT by assessing the clinical and pathological features of the patients who met the inclusion criteria. We also assessed the significance of survival outcomes using Mantel-Cox univariate and multivariate analyses. The subgroups of patients with stages I, II, and III disease who received single-, dual-, or triple-drug regimens following surgery were analyzed using SPSS 25.0 and the ggplot2 package in R 4.3.0.
RESULTS: In all, 530 eligible individuals with RGAVCT were enrolled in this study. The median overall survival (OS) of patients with RGAVCT was 24 months, and the survival rates were 80.2%, 62.5%, and 42.3% at 12, 24, and 59 months, respectively. Preoperative complications, tumor size, T stage, and postoperative chemotherapy were identified as independent factors that influenced OS in patients with RGAVCT according to the Cox multivariate analysis model. A Kaplan-Meier analysis revealed that chemotherapy had no effect on OS of patients with stage I or II RGAVCT; however, chemotherapy did have an effect on OS of stage III patients. Stage III patients who were treated with chemotherapy consisting of dual- or triple-agent regimens had better survival than those treated with single-agent regimens, and no significant difference was observed in the survival of patients treated with chemotherapy consisting of dual- or triple-agent regimens.
CONCLUSIONS: For patients with stage III RGAVCT, a dual-agent regimen of postoperative chemotherapy should be recommended rather than a triple-agent treatment, as the latter is associated with increased frequency of adverse events.