Impact of pathological complete response on survival in gastric cancer after neoadjuvant chemotherapy: a propensity score matching analysis.

IF 2.5 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY BMC Gastroenterology Pub Date : 2025-01-09 DOI:10.1186/s12876-025-03594-8

Yonghe Chen, Jiasheng He, Jiabo Zheng, Yi Lin, Huashe Wang, Lei Lian, Junsheng Peng

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Abstract

Purpose: The survival benefits of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC) patients are inconsistent. This study aims to investigate how different tumor regression grades (TRG) influence the survival gains associated with NAC treatment.

Methods: This study compared the treatment outcomes of patients who underwent CSC (neoadjuvant chemotherapy - surgery - adjuvant chemotherapy) with those receiving traditional SC (surgery - adjuvant chemotherapy) treatment. Propensity score matching (PSM) was employed to minimize potential biases arising from differences in baseline characteristics and intervention factors between the treatment groups. After PSM, the CSC cohort was stratified according to TRGs, and their survival outcomes were compared to assess the impact of TRGs on survival gains associated with NAC.

Results: Before PSM, a total of 506 patients were enrolled: 291 in the CSC cohort and 215 in the SC cohort. The CSC cohort had a lower 3-year survival rate (3Y-SR) than the SC cohort (64.6% vs. 76%). In the CSC cohort, patients who achieved pathological complete response (pCR, 12.1%, 26/215) demonstrated significantly improved 3Y-SR (95.5%). After PSM, 110 patients were matched in each cohort. The 3Y-SR was similar between the CSC cohort (68.3%) and the SC cohort (63.6%). In the CSC cohort, 12.7% (14/110) of patients achieved pCR. Subgroup analysis revealed that the pCR subgroup (3Y-SR 100%) was the only subgroup within the CSC cohort that maintained significantly improved survival compared to the SC cohort. Better tumor differentiation was the only pre-treatment factor significantly associated with achieving pCR (p < 0.001).

Conclusion: In this retrospective study, LAGC patients who achieved pCR after NAC demonstrated significantly better survival outcomes compared to other response groups. The study found tumor differentiation was a potential predictor of pCR.

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胃癌新辅助化疗后病理完全缓解对生存的影响：倾向评分匹配分析。

目的：局部晚期胃癌（LAGC）患者新辅助化疗（NAC）的生存获益不一致。本研究旨在探讨不同肿瘤消退等级（TRG）如何影响NAC治疗相关的生存获益。方法：本研究比较了接受CSC（新辅助化疗-手术-辅助化疗）和传统SC（手术-辅助化疗）治疗的患者的治疗结果。采用倾向评分匹配（PSM）来减少治疗组之间基线特征和干预因素差异引起的潜在偏差。PSM后，根据trg对CSC队列进行分层，并比较他们的生存结果，以评估trg对NAC相关生存收益的影响。结果：在PSM之前，共有506例患者入组：CSC队列291例，SC队列215例。CSC组的3年生存率（3Y-SR）低于SC组（64.6% vs 76%）。在CSC队列中，达到病理完全缓解（pCR, 12.1%, 26/215）的患者表现出明显改善的3Y-SR（95.5%）。PSM后，每个队列中有110例患者匹配。CSC组（68.3%）和SC组（63.6%）的3Y-SR相似。在CSC队列中，12.7%（14/110）的患者实现了pCR。亚组分析显示，与SC队列相比，pCR亚组（3Y-SR 100%）是CSC队列中唯一维持显着改善生存率的亚组。更好的肿瘤分化是唯一与实现pCR显著相关的治疗前因素(p)。结论：在本回顾性研究中，NAC后实现pCR的LAGC患者的生存结果明显优于其他反应组。研究发现肿瘤分化是pCR的潜在预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Gastroenterology 医学-胃肠肝病学

CiteScore

4.20

自引率

0.00%

发文量

465

审稿时长

6 months

期刊介绍： BMC Gastroenterology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of gastrointestinal and hepatobiliary disorders, as well as related molecular genetics, pathophysiology, and epidemiology.