胃腺癌根治术后新辅助化疗与长期死亡率的关系

Neoadjuvant chemotherapy in relation to long-term mortality in individuals cured of gastric adenocarcinoma

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Gastric Cancer

影响因子:5.1

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

DOI: 10.1007/s10120-024-01558-7

摘要

化疗的晚期效应可能影响癌症幸存者的死亡率。本研究旨在明确胃腺癌新辅助化疗是否影响痊愈患者的长期生存。本为一项全国性、基于人群的队列研究，纳入2006年至2015年在瑞典接受胃切除术治疗胃腺癌且术后存活≥5年的所有患者。随访至死亡或研究结束（2020年12月31日）。采用多变量Cox比例风险模型，计算风险比（HR）及其95%置信区间（CI），调整年龄、性别、合并症、教育水平、年份、肿瘤亚部位、住院并发症和脾切除等因素。数据来源为医疗记录和全国性登记资料。在613名胃腺癌幸存者中，接受新辅助化疗（269例，占43.9%）与较低的粗死亡率相关（HR 0.66，95% CI：0.46-0.96）。但调整所有混杂因素后，相关性减弱且不具有统计学意义（HR 0.83，95% CI：0.56-1.23）；仅调整年龄和合并症后，亦无显著差异（HR 0.82，95% CI：0.56-1.20）。分层分析未发现新辅助化疗与不同年龄、性别、合并症、年份和肿瘤亚部位类别中的长期死亡率有显著关联。结论：新辅助化疗未能改善胃腺癌幸存者的长期生存。接受新辅助化疗的患者多为年轻、伴随较少严重合并症者，生存前景相对较好，属于选择性群体。

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.