ADJUVANT CHEMORADIOTHERAPY AFTER SUBTOTAL OR TOTAL GASTRECTOMY AND D2 LIMPHADENECTOMY INCREASES SURVIVAL IN ADVANCED GASTRIC CANCER?

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.

摘要 背景：进展期胃癌的根治性治疗以手术为核心手段，放化疗可作为新辅助或辅助治疗方案，用于控制病情进展并延长患者生存期。目的：评估接受D2淋巴结清扫术（D2 lymphadenectomy）的次全或全胃切除术患者，术后接受辅助放化疗（adjuvant chemoradiotherapy）后的生存状况。方法：回顾性分析87例已接受胃切除术的进展期胃腺癌患者，临床分期为IB至IIIC期，所有患者均接受INT 0116方案辅助放化疗。排除食管胃交界处肿瘤、存在腹膜种植灶、远处转移、手术切缘受累或术后早期死亡的病例。根据胃切除术式将患者分组，分析肿瘤发生部位、病理组织学特征、淋巴结侵犯情况、临床分期、并发症发生率及生存结局。结果：成功完成全程辅助放化疗的患者共45例，占比51.7%；因治疗毒性反应、肿瘤相关病情恶化或失访而中断治疗的患者共10例，占比11.5%，归类为辅助治疗不完整组；拒绝辅助治疗或未启动辅助治疗的患者共33例，占比48.3%。其中行次全胃切除术者60例（68.9%），全胃切除术者27例（31.1%），全胃切除术患者的生存期更短。本研究中平均清扫淋巴结数目为30.8枚。临床分期与受侵淋巴结数量是不良生存预后的预测因素，且肿瘤分期越晚，生存预后越差。完成完整辅助放化疗的患者，其生存期显著长于辅助治疗不完整者或仅接受手术治疗的患者。进一步对比T4b（IIIB+IIIC期）患者亚组：接受完整辅助治疗者与仅接受手术或辅助治疗未完成者相比，生存结局存在显著差异。结论：对于接受根治性手术治疗的T4b期进展期胃癌患者，辅助放化疗可带来明确的生存获益。