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Advantages of ypTNM Staging in Post-surgical Prognosis for Initially Unresectable or Stage IV Gastric Cancers
Journal of Gastric Cancer ( IF 2.5 ) Pub Date : 2020-01-01 , DOI: 10.5230/jgc.2020.20.e20
Gyu-Seong Jeong 1 , In-Seob Lee 1 , Young-Soo Park 2 , Beom-Su Kim 1 , Moon-Won Yoo 1 , Jeong-Hwan Yook 1 , Byung-Sik Kim 1
Affiliation  

Purpose For unresectable or initially metastatic gastric cancer, conversion surgery (CVS), after systemic chemotherapy, has received attention as a treatment strategy. This study evaluated the prognostic value of ypTNM stage and the oncologic outcomes in patients receiving CVS. Materials and Methods A retrospective review of clinicopathologic findings and oncologic outcomes of 116 patients who underwent CVS with curative intent, after combination chemotherapy, between January 2000 and December 2015, has been reported here. Results Twenty-six patients (22.4%) underwent combined resection of another organ and 12 patients received para-aortic lymphadenectomy (10.3%). Pathologic complete remission (CR) was confirmed in 11 cases (9.5%). The median overall survival (OS) and disease-free survival (DFS) times were 35.0 and 21.3 months, respectively. In multivariate analysis, ypTNM stage was the sole independent prognostic factor for DFS (P=0.042). Tumors invading an adjacent organ or involving distant lymph nodes showed better survival than those with peritoneal seeding or solid organ metastasis (P=0.084). Kaplan-Meier curves showed that the 3-year OS rate of patients with pathologic CR and those with CR of the primary tumor but residual node metastasis was 81.8% and 80.0%, respectively. OS was 65.8% for stage 1 patients, 49.8% for those at stage 2, and 36.3% for those at stage 3. Conclusions The ypTNM staging is a significant prognostic factor in patients who underwent CVS for localized unresectable or stage IV gastric cancers. Patients with locally advanced but unresectable lesions or with tumors with distant nodal metastasis may be good candidates for CVS.

中文翻译:

ypTNM 分期在初始不可切除或 IV 期胃癌术后预后中的优势

目的对于不可切除或初始转移性胃癌,全身化疗后的转化手术(CVS)作为一种治疗策略受到了关注。本研究评估了 ypTNM 分期的预后价值和接受 CVS 的患者的肿瘤学结果。材料和方法 对 2000 年 1 月至 2015 年 12 月联合化疗后接受 CVS 治疗的 116 名患者的临床病理学结果和肿瘤学结果进行回顾性分析。结果 26例(22.4%)患者接受了其他器官联合切除术,12例患者接受了主动脉旁淋巴结清扫术(10.3%)。11例(9.5%)证实病理完全缓解(CR)。中位总生存期 (OS) 和无病生存期 (DFS) 时间分别为 35.0 个月和 21.3 个月。在多变量分析中,ypTNM 分期是 DFS 的唯一独立预后因素(P=0.042)。侵犯邻近器官或累及远处淋巴结的肿瘤比腹膜种植或实体器官转移的肿瘤存活率更高(P=0.084)。Kaplan-Meier曲线显示病理性CR患者和原发肿瘤CR但残留淋巴结转移患者的3年OS率分别为81.8%和80.0%。1 期患者的 OS 为 65.8%,2 期患者为 49.8%,3 期患者为 36.3%。结论 ypTNM 分期是局部不可切除或 IV 期胃癌接受 CVS 的患者的重要预后因素。局部晚期但无法切除的病变或有远处淋巴结转移的患者可能是 CVS 的良好候选者。ypTNM 分期是 DFS 的唯一独立预后因素(P=0.042)。侵犯邻近器官或累及远处淋巴结的肿瘤比腹膜种植或实体器官转移的肿瘤存活率更高(P=0.084)。Kaplan-Meier曲线显示病理性CR患者和原发肿瘤CR但残留淋巴结转移患者的3年OS率分别为81.8%和80.0%。1 期患者的 OS 为 65.8%,2 期患者为 49.8%,3 期患者为 36.3%。 结论 ypTNM 分期是局部不可切除或 IV 期胃癌接受 CVS 的患者的重要预后因素。局部晚期但无法切除的病变或有远处淋巴结转移的患者可能是 CVS 的良好候选者。ypTNM 分期是 DFS 的唯一独立预后因素(P=0.042)。侵犯邻近器官或累及远处淋巴结的肿瘤比腹膜种植或实体器官转移的肿瘤存活率更高(P=0.084)。Kaplan-Meier曲线显示病理性CR患者和原发肿瘤CR但残留淋巴结转移患者的3年OS率分别为81.8%和80.0%。1 期患者的 OS 为 65.8%,2 期患者为 49.8%,3 期患者为 36.3%。结论 ypTNM 分期是局部不可切除或 IV 期胃癌接受 CVS 的患者的重要预后因素。局部晚期但无法切除的病变或有远处淋巴结转移的患者可能是 CVS 的良好候选者。侵犯邻近器官或累及远处淋巴结的肿瘤比腹膜种植或实体器官转移的肿瘤存活率更高(P=0.084)。Kaplan-Meier曲线显示病理性CR患者和原发肿瘤CR但残留淋巴结转移患者的3年OS率分别为81.8%和80.0%。1 期患者的 OS 为 65.8%,2 期患者为 49.8%,3 期患者为 36.3%。 结论 ypTNM 分期是局部不可切除或 IV 期胃癌接受 CVS 的患者的重要预后因素。局部晚期但无法切除的病变或有远处淋巴结转移的患者可能是 CVS 的良好候选者。侵犯邻近器官或累及远处淋巴结的肿瘤比腹膜种植或实体器官转移的肿瘤存活率更高(P=0.084)。Kaplan-Meier曲线显示病理性CR患者和原发肿瘤CR但残留淋巴结转移患者的3年OS率分别为81.8%和80.0%。1 期患者的 OS 为 65.8%,2 期患者为 49.8%,3 期患者为 36.3%。 结论 ypTNM 分期是局部不可切除或 IV 期胃癌接受 CVS 的患者的重要预后因素。局部晚期但无法切除的病变或有远处淋巴结转移的患者可能是 CVS 的良好候选者。
更新日期:2020-01-01
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