与胃腺癌治愈的个体长期死亡率有关的新辅助化疗与长期死亡率有关
Neoadjuvant chemotherapy in relation to long-term mortality in individuals cured of gastric adenocarcinoma
影响因子:5.10000
分区:医学2区 / 胃肠肝病学2区 肿瘤学2区
发表日期:2025 Jan
作者:
Wilhelm Leijonmarck, Fredrik Mattsson, Jesper Lagergren
摘要
化学疗法的后期作用可能会影响癌症幸存者的死亡率。这项研究旨在澄清胃腺癌的新辅助化疗是否会影响固化这种肿瘤的个体的长期生存。这是一项全国性和基于人群的同类研究，其中包括所有在2006年和2015年间曾在瑞典的胃腺癌进行胃切除术的人，并在2015年和2015年间为苏尔而生存。随访该队列直到死亡或研究结束期（2020年12月31日）。多变量COX比例危害回归用于提供95％置信区间（CI）的危害比（HR）。针对年龄，性别，合并症，教育，日历年，肿瘤子站点，院内并发症和脾切除术对人力资源进行调整。数据来自医疗记录和全国范围内的记录。Amongst613胃腺癌幸存者，新辅助化疗（在269名患者中使用； 43.9％）与原油死亡率降低有关（HR 0.66，95％CI 0.46-0.96）。然而，在调整所有混杂因素后，该协会在调整后（HR 0.83，95％CI 0.56-1.23）和仅针对年龄和合并症（HR 0.82，95％CI 0.56-1.20）进行了调整后的统计学不显着（HR 0.83，95％CI 0.56-1.23）。分层的分析没有揭示新辅助化疗与年龄，性别，合并症，日历年和肿瘤亚位置的长期死亡率之间的任何统计学意义。NeoAdjuvant化学疗法并没有降低胃腺癌存活者之间的长期生存。接受新辅助化学疗法的患者是一个选定的组，其特征是年龄较小，严重合并症较少，因此长期生存的机会更好。
Abstract
Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46-0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56-1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56-1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.