| 柴腾蛟,朱诚康,黄兴茂,等.老年进展期胃癌患者新辅助化疗疗效及预后相关因素分析[J].肿瘤学杂志,2024,30(10):797-804. |
| 老年进展期胃癌患者新辅助化疗疗效及预后相关因素分析 |
| Efficacy of Neoadjuvant Chemotherapy in Elderly Patients with Locally Advanced Gastric Cancer and Influencing Factors of Prognosis |
| 投稿时间：2024-07-18 |
| DOI：10.11735/j.issn.1671-170X.2024.10.B001 |
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| 中文关键词: 胃肿瘤 进展期 老年人 新辅助化疗 疗效 预后 |
| 英文关键词:gastric neoplasms locally advanced elderly neoadjuvant chemotherapy efficacy prognosis |
| 基金项目:浙江省自然科学基金重点项目（LBZ22H160002） |
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| 中文摘要: |
| 摘 要：［目的］ 探索新辅助化疗在老年进展期胃癌患者中的疗效以及影响此类患者预后的相关因素。［方法］ 回顾性收集2012年1月1日至2022年12月31日期间在浙江省肿瘤医院接受新辅助化疗和手术治疗的154例老年（≥70岁）进展期胃癌患者临床病理信息；评估患者新辅助化疗后病理退缩程度，确定影响老年进展期胃癌患者预后的相关因素。［结果］ 共入组154例老年进展期胃癌患者，所有入组患者均接受了术前新辅助化疗和胃癌根治手术。全组90.3%患者完成了2个周期及以上新辅助化疗；3~4级不良反应发生率为17.5%。病理完全缓解率和主要病理缓解率分别为7.8%和32.5%。R0切除率为97.4%，Clavien-Dindo Ⅱ~Ⅲ级术后并发症发生率为12.3%；1、3、5年总生存率分别为84.4%、53.2%和44.3%。亚组分析显示新辅助化疗响应组（TRG1a或TRG1b）和未响应组（TRG2或TRG3）的总生存率差异有统计学意义（P<0.001）；淋巴结比例低、术后预后营养指数高的老年患者总体预后较好；Cox多因素分析发现肿瘤大小（≥5 cm）、术前CEA水平（>5 ng/mL）和脉管癌栓（有）为老年进展期胃癌患者的独立危险预后因素。［结论］ 在老年进展期胃癌患者中，施行术前新辅助化疗安全性良好，可有效降低肿瘤负荷，对新辅助化疗响应良好的患者可获得更好的预后。 |
| 英文摘要: |
| Abstract：［Objective］ To assess the efficacy of neoadjuvant chemotherapy in elderly patients with locally advanced gastric cancer， and the factors influencing the prognosis of patients. ［Methods］ Clinical and pathological data of 154 patients aged ≥70 years with locally advanced gastric cancer who underwent preoperative neoadjuvant chemotherapy and radical gastrectomy in Zhejiang Cancer Hospital from January 2012 to December 2022 were retrospectively analyzed. The efficacy of neoadjuvant chemotherapy was assessed and the factors influencing the prognosis of patients were analyzed. ［Results］ In this cohort， 90.3% of patients completed two or more cycles of neoadjuvant chemotherapy. The incidence of Grade 3～4 adverse events was 17.5%. The pathological complete response and major pathological response rates are 7.8% and 32.5%， respectively. The R0 resection rate was 97.4%， and the incidence of Clavien-Dindo Grade Ⅱ~Ⅲ postoperative complications was 12.3%. The 1-year， 3-year， and 5-year overall survival were 84.4%， 53.2% and 44.3%， respectively. There was significant difference in overall survival between the neoadjuvant chemotherapy response group (TRG1a or TRG1b) and the non-response group (TRG2 or TRG3) (P<0.001). Additionally， patients with less metastatic lymph nodes and a higher postoperative prognostic nutritional index demonstrated a better overall prognosis. Multivariate Cox regression analysis revealed that tumor size ≥5 cm， preoperative CEA level >5 ng/mL and presence of vascular cancer thrombus were independent risk factors of poorer prognosis of patients. ［Conclusion］ For elderly patients with locally advanced gastric cancer， neoadjuvant chemotherapy can effectively reduce tumor burden and improve the prognosis of those who respond well to neoadjuvant chemotherapy with manageable safety. |
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