Impact of gastrectomy on efficacy and safety of second-line chemotherapy patients with advanced gastric cancer: Exploratory analysis of two randomized phase III trials

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Kazuhiro Nishikawa, Wasaburo Koizumi, Akira Tsuburaya, Motoko Suzuki, Satoshi Morita, Kazumasa Fujitani, Yusuke Akamaru, Ken Shimada, Hisashi Hosaka, Ken Nishimura, Takaki Yoshikawa, Toshimasa Tsujinaka, Junichi Sakamoto
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引用次数: 0

Abstract

Aims

Second-line chemotherapy (SLC) improves survival in advanced gastric cancer (AGC). Although many patients receiving SLC have undergone gastrectomy, the impact of gastrectomy on SLC remains unclear.

Patients and Methods

The objective was to evaluate the impact of gastrectomy on SLC for AGC. A total of 290 eligible patients registered in two randomized phase III trials evaluating SLC for patients with AGC was classified into the prior gastrectomy group (PGG; n = 187) or the no gastrectomy group (NGG; n = 103). We compared overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and safety between these two groups. Adjusted OS and adjusted PFS were estimated using inverse probability of treatment weighting (IPTW).

Results

The PGG had better performance status (p = 0.001), more prior platinum agent (p < 0.001), and more frequent peritoneal metastasis (p = 0.006) than the NGG. The PGG had significantly better OS (13.8 vs. 9.3 mo; hazard ratio [HR]: 0.59; p < 0.001) and PFS (4.7 vs. 2.8 mo; HR: 0.58; p < 0.001) than the NGG. The PGG had significantly better adjusted OS (13.8 vs. 10.0 mo; IPTW HR: 0.66; p = 0.01) and adjusted PFS (4.3 vs. 3.2 mo; IPTW HR: 0.71; p = 0.027) than the NGG. No significant differences were observed in ORR and DCR. The incidence of Grade 3 or worse adverse events did not differ between the two groups except for a high incidence of anemia and diarrhea in the NGG.

Conclusion

Patients with previous gastrectomy are expected to have better survival outcomes when receiving second-line irinotecan (IRI)-based chemotherapy for AGC.

Abstract Image

胃切除术对晚期胃癌患者二线化疗疗效和安全性的影响:两项随机III期试验的探索性分析
目的:二线化疗(SLC)可提高晚期胃癌(AGC)患者的生存率。虽然许多接受SLC的患者都进行了胃切除术,但胃切除术对SLC的影响尚不清楚。目的是评价胃切除术对AGC患者SLC的影响。在两项评估AGC患者SLC的随机III期试验中,共有290名符合条件的患者被分为先前胃切除术组(PGG;n = 187)或未行胃切除术组(NGG;n = 103)。我们比较了两组的总生存期(OS)、无进展生存期(PFS)、总缓解率(ORR)、疾病控制率(DCR)和安全性。调整后的OS和调整后的PFS采用治疗加权逆概率(IPTW)估计。结果与NGG相比,PGG表现更好(p = 0.001),既往使用铂类药物较多(p < 0.001),腹膜转移发生率较高(p = 0.006)。PGG的OS明显更好(13.8 vs 9.3;风险比[HR]: 0.59;p < 0.001)和PFS (4.7 vs 2.8个月;人力资源:0.58;p < 0.001)大于NGG。PGG的调整OS明显更好(13.8 vs 10.0;Iptw hr: 0.66;p = 0.01)和调整后的PFS (4.3 vs. 3.2;Iptw hr: 0.71;p = 0.027)。ORR和DCR无显著差异。除了NGG组贫血和腹泻发生率较高外,两组间3级或更严重不良事件的发生率没有差异。结论既往胃切除术患者接受以伊立替康(IRI)为基础的二线化疗治疗AGC有望获得更好的生存结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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