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pT1N1M0早期胃癌术后辅助治疗临床意义的探索
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Abstract:
背景：pT1N1M0分期胃癌术后辅助治疗目前各大指南无统一共识。本研究的目的是确定辅助放化疗对pT1N1M0胃癌根治术后患者有无生存获益，分析影响pT1N1M0胃癌患者预后的危险因素。方法：从SEER数据库中选择2004年至2019年胃切除术后pT1N1M0 GC患者319例。采用Kaplan-Meier法和log-rank检验分析总生存率。采用Cox比例风险回归模型对影响pT1N1M0胃癌根治性切除患者预后的因素进行单变量和多变量分析。结果：生存分析显示术后辅助化疗(5年OS：52.4% vs. 75.8%，p < 0.001)和辅助放疗(5年OS: 59.9% vs. 71.9%，p = 0.001)可显著延长pT1N1M0胃癌患者的生存期。多因素Cox回归分析显示年龄(p = 0.001)，原发部位(p = 0.009)，检查淋巴结数量(ELNC) (p = 0.007)和辅助化疗(p = 0.006)是与OS相关的独立预后因素。这些变量符合Cox回归比例风险假设检验(p > 0.05)。结论：术后辅助化疗及辅助放疗能够改善pT1N1M0 GC患者OS，年龄、辅助化疗、肿瘤部位、ELNC是pT1N1M0胃癌预后的独立影响因素。
Background: Currently, there is no consensus on postoperative adjuvant therapy for pT1N1M0 gastric cancer in major guidelines. The aim of this study is to determine the survival benefit of adjuvant chemoradiotherapy in patients with pT1N1M0 gastric cancer after radical gastrectomy, and to analyze the risk factors affecting the prognosis of patients with pT1N1M0 gastric cancer. Methods: A total of 319 patients with pT1N1M0 GC after gastrectomy from 2004 to 2019 were selected from the SEER database. Kaplan-Meier method and log-rank test were used to analyze the overall survival rate. Univariate and multivariate analyses of prognostic factors of patients with pT1N1M0 gastric cancer after radical resection were performed using Cox proportional hazards regression model. Results: Survival analysis showed that postoperative adjuvant chemotherapy (5-year OS: 52.4% vs. 75.8%, p < 0.001) and adjuvant radiotherapy (5-year OS: 59.9% vs. 71.9%, p = 0.001) could significantly prolong the survival of patients with pT1N1M0 gastric cancer. Multivariate Cox regression analysis showed that age (p = 0.001), primary site (p = 0.009), number of examined lymph node count (ELNC) (p = 0.007) and adjuvant chemotherapy (p = 0.006) were independent prognostic factors associated with OS. These variables were in accordance with the Cox regression proportional hazards hypothesis test (p > 0.05). Conclusions: Postoperative adjuvant chemotherapy and radiotherapy can improve the OS of patients with pT1N1M0 GC. Age, adjuvant chemotherapy, tumor location, and ELNC are independent prognostic factors for pT1N1M0 gastric cancer.
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