Archana Elangovan, Prasanth Penumadu, Biswajit Dubashi, N Sreekumaran Nair, Balasubramanian A
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引用次数: 0
Abstract
Background: A uniform consensus on the optimal sequencing of treatment modalities in locally advanced gastric cancer is not reached due to conflicting results worldwide. We conducted a retrospective propensity-matched analysis to compare survival of locally advanced gastric cancer patients who were treated with peri-operative chemotherapy followed by surgery or upfront surgery followed by adjuvant chemotherapy.
Methods: Deidentified records of prospectively maintained data of locally advanced gastric cancer patients treated from 2015 to 2020 were collected. A 1:1 propensity matching with a tolerance limit of 0.2 was performed. The outcome variables including recurrence-free and overall survival were compared among the matched groups using log-rank tests and Cox proportional hazards analysis was performed.
Results: Two hundred patients (64 in peri-operative chemotherapy and 136 in the upfront surgery group) were included in the study. Variables including age group, sex, gastric outlet obstruction, tumor site, clinical T stage and node positivity were used for matching. The median overall survival and recurrence-free survival were found to be 21.90 months (95% CI = 13.30-30.49) and 15.08 months (95% CI = 8.17-21.98), respectively, in the peri-operative chemotherapy arm and 18.70 months (95% CI = 11.88-25.51) and 13.49 months (95% CI = 6.76-20.21), respectively, in upfront surgery arm with no significant difference (median follow-up 42 months). Patients who presented with pallor had Borrmann type 4 on endoscopy, received lesser number of chemotherapy cycles, lymph node ratio was > 0.13 and perineural invasion were associated with worse overall survival and recurrence-free survival.
Conclusion: In this real-world scenario, retrospective propensity-matched study, no difference was noted in overall survival and recurrence-free survival between patients who received peri-operative chemotherapy or upfront surgery followed by adjuvant chemotherapy in locally advanced gastric cancer.
背景：由于世界范围内相互矛盾的结果，局部晚期胃癌治疗方式的最佳顺序尚未达成统一的共识。我们进行了回顾性倾向匹配分析，比较局部晚期胃癌患者围手术期化疗后手术或术前化疗后辅助化疗的生存率。方法：收集2015 - 2020年局部晚期胃癌患者前瞻性维护数据的未识别记录。进行了1:1的倾向匹配，容忍极限为0.2。采用对数秩检验比较匹配组间无复发和总生存等结局变量，并进行Cox比例风险分析。结果：共纳入200例患者，其中围手术期化疗64例，术前手术组136例。采用年龄、性别、胃出口梗阻、肿瘤部位、临床T分期、淋巴结阳性等变量进行匹配。围手术期化疗组的中位总生存期和无复发生存期分别为21.90个月（95% CI = 13.30-30.49）和15.08个月（95% CI = 8.17-21.98），术前组的中位总生存期和无复发生存期分别为18.70个月（95% CI = 11.88-25.51）和13.49个月（95% CI = 6.76-20.21），差异无统计学意义（中位随访42个月）。出现苍白的患者内镜检查为Borrmann 4型，接受化疗周期数较少，淋巴结比为>.13，神经周围浸润与总生存期和无复发生存期较差相关。结论：在本真实场景中，回顾性倾向匹配研究中，局部晚期胃癌患者接受围手术期化疗或术前辅助化疗的总生存期和无复发生存期无差异。
期刊介绍：
The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.
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