局部晚期胃癌根治术后放化疗患者复发模式及预后因素分析

doi:10.3760/cma.j.cn113030-20210906-00348

Abstract
Figure/Table
References()
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To retrospectively analyze prognostic factors and patterns of recurrence in locally advanced gastric cancer patients receiving chemoradiotherapy (CRT) after radical gastrectomy, aiming to provide reference for postoperative CRT of locally advanced gastric cancer. Methods Clinical data of 171 patients with curatively resected gastric carcinoma who received postoperative CRT in our hospital between 2008 and 2020 were retrospectively analyzed. The disease-free survival and overall survival (OS) rates were calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by Cox model. Results The median follow-up duration was 63 months. The follow-up rate was 93.6%. 31.0% and 66.7% of the enrolled patients were classified in pathological stage Ⅱ and Ⅲ. The acute grade 3 or 4 gastrointestinal and hematological toxicity rates were 8.8% and 9.9%, respectively. In total, 166 patients completed the entire CRT regimen. No toxicity-related death occurred. Regarding patterns of recurrence, 17 patients had locoregional recurrence, 29had distant metastasis and 12had peritoneal metastasis. The 1-, 3-and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, while the 1-, 3-and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. In the multivariate analysis, pathological T stage, perineural invasion and lymph node ratio (LNR) were found to be the independent predictors of OS. Conclusions Postoperative intensity-modulated radiation therapy and chemotherapy are well tolerated, with acceptable toxicities and encouraging locoregional tumor control and long-term survival. LNR can be used as an independent prognostic indicator for OS. Adjuvant CRT should be considered for all patients with a high risk of locoregional recurrence.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Ma Yifu
	Yang Yongqiang
	Xing Pengfei
	Wu Yongyou
	Zhang Liyuan

Key words： Gastric cancer/radiotherapy Gastric cancer/chemoradiotherapy Lymph node ratio Adjuvant therapy

Received: 06 September 2021

Fund:Suzhou Clinical Key Disease Diagnosis and Treatment Technology Project (LCZX201808);Suzhou Key Laboratory of Tumor Radiotherapy (szs2020309);Provincial Key Laboratory of Soochow University (KJS1961);Jiangsu Provincial Key Project (BE2021652)

Corresponding Authors: Zhang Liyuan, Email:zhangliyuan126@126.com

Cite this article:

Ma Yifu,Yang Yongqiang,Xing Pengfei et al. Analysis of patterns of recurrence and prognostic factors in 171 locally advanced gastric cancer patients with radiotherapy and concurrent chemotherapy after radical gastrectomy[J]. Chinese Journal of Radiation Oncology, 2022, 31(5): 438-444.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20210906-00348 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2022/V31/I5/438

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492.
[2] The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017:a systematic analysis for the global burden of disease study 2017[J]. Lancet Gastroenterol Hepatol, 2020, 5(1):42-54. DOI:10.1016/S2468-1253(19)30328-0.
[3] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI:10.3322/caac.21338.
[4] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567. DOI:10.1016/S2214-109X(18)30127-X.
[5] Liu D, Lu M, Li J, et al. The patterns and timing of recurrence after curative resection for gastric cancer in China[J]. World J Surg Oncol, 2016, 14(1):305. DOI:10.1186/s12957-016-1042-y.
[6] Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116:a phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection[J]. J Clin Oncol, 2012, 30(19):2327-2333. DOI:10.1200/JCO.2011.36.7136.
[7] Van Cutsem E, Sagaert X, Topal B, et al. Gastric cancer[J]. Lancet, 2016, 388(10060):2654-2664. DOI:10.1016/S0140-6736(16)30354-3.
[8] Yu JI, Lim DH, Lee J, et al. Necessity of adjuvant concurrent chemo-radiotherapy in D2-resected LN-positive gastric cancer[J]. Radiother Oncol, 2018, 129(2):306-312. DOI:10.1016/j.radonc.2018.07.002.
[9] Park SH, Sohn TS, Lee J, et al. Phase Ⅲ trial to compare adjuvant chemotherapy with capecitabine and cisplatin versus concurrent chemoradiotherapy in gastric cancer:final report of the adjuvant chemoradiotherapy in stomach tumors trial, including survival and subset analyses[J]. J Clin Oncol, 2015, 33(28):3130-3136. DOI:10.1200/JCO.2014.58.3930.
[10] Yu JI, Lim DH, Ahn YC, et al. Effects of adjuvant radiotherapy on completely resected gastric cancer:A radiation oncologist's view of the ARTIST randomized phase Ⅲ trial[J]. Radiother Oncol, 2015, 117(1):171-177. DOI:10.1016/j.radonc.2015.08.009.
[11] Ji X, Bu ZD, Yan Y, et al. The 8^th edition of the American joint committee on cancer tumor-node-metastasis staging system for gastric cancer is superior to the 7^th edition:results from a Chinese mono-institutional study of 1663 patients[J]. Gastric Cancer, 2018, 21(4):643-652. DOI:10.1007/s10120-017-0779-5.
[12] Yang Y, Xing P, Zhou N, et al. The necessity of adjuvant radiotherapy for locally advanced gastric cancer in China[J]. Transl Cancer Res, 2019, 8(2):676-682. DOI:10.21037/tcr.2019.03.11.
[13] Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015:A systematic analysis for the global burden of disease study[J]. JAMA Oncol, 2017, 3(4):524-548. DOI:10.1001/jamaoncol.2016.5688.
[14] Deng J, Zhang R, Pan Y, et al. Comparison of the staging of regional lymph nodes using the sixth and seventh editions of the tumor-node-metastasis (TNM) classification system for the evaluation of overall survival in gastric cancer patients:findings of a case-control analysis involving a single institution in China[J]. Surgery, 2014, 156(1):64-74. DOI:10.1016/j.surg.2014.03.020.
[15] Xiao LB, Yu JX, Wu WH, et al. Superiority of metastatic lymph node ratio to the 7^th edition UICC N staging in gastric cancer[J]. World J Gastroenterol, 2011, 17(46):5123-5130. DOI:10.3748/wjg.V17.i46.5123.
[16] Wang W, Xu DZ, Li YF, et al. Tumor-ratio-metastasis staging system as an alternative to the 7^th edition UICC TNM system in gastric cancer after D2 resection—results of a single-institution study of 1343 Chinese patients[J]. Ann Oncol, 2011, 22(9):2049-2056. DOI:10.1093/annonc/mdq716.
[17] Ueno D, Matsumoto H, Kubota H, et al. Prognostic factors for gastrectomy in elderly patients with gastric cancer[J]. World J Surg Oncol, 2017, 15(1):59. DOI:10.1186/s12957-017-1131-6.
[18] Jabo B, Selleck MJ, Morgan JW, et al. Role of lymph node ratio in selection of adjuvant treatment (chemotherapy vs. chemoradiation) in patients with resected gastric cancer[J]. J Gastrointest Oncol, 2018, 9(4):708-717. DOI:10.21037/jgo.2018.05.12.
[19] Hwang JE, Kim H, Shim HJ, et al. Lymph-node ratio is an important clinical determinant for selecting the appropriate adjuvant chemotherapy regimen for curative D2-resected gastric cancer[J]. J Cancer Res Clin Oncol, 2019, 145(8):2157-2166. DOI:10.1007/s00432-019-02963-7.
[20] Noh SH, Park SR, Yang HK, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC):5-year follow-up of an open-label, randomised phase 3 trial[J]. Lancet Oncol, 2014, 15(12):1389-1396. DOI:10.1016/S1470-2045(14)70473-5.
[21] Sasako M, Sakuramoto S, Katai H, et al. Five-year outcomes of a randomized phase Ⅲ trial comparing adjuvant chemotherapy with s-1 versus surgery alone in stage Ⅱ or Ⅲ gastric cancer[J]. J Clin Oncol, 2011, 29(33):4387-4393. DOI:10.1200/JCO.2011.36.5908.
[22] Ychou M, Boige V, Pignon JP, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma:an FNCLCC and FFCD multicenter phase Ⅲ trial[J]. J Clin Oncol, 2011, 29(13):1715-1721. DOI:10.1200/JCO.2010.33.0597.
[23] Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer[J]. N Engl J Med, 2006, 355(1):11-20. DOI:10.1056/NEJMoa055531.
[24] Ren F, Li S, Zhang Y, et al. Efficacy and safety of intensity-modulated radiation therapy versus three-dimensional conformal radiation treatment for patients with gastric cancer:a systematic review and meta-analysis[J]. Radiat Oncol, 2019, 14(1):84. DOI:10.1186/s13014-019-1294-0.