Risk-stratification model to select conversion surgery for advanced gastric cancer patients
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摘要
Objective: Conversion surgery is a surgery with a purpose of R0 resection in primary advanced gastric cancer(GC) that responded well to systemic chemotherapy. This study aimed to explore the efficacy of conversion surgery for advanced GC.Methods: A total of 618 advanced GC patients receiving systemic chemotherapy were stratified into low-,moderate-and high-risk groups based on a nomogram-predicted probability of overall survival. The survival of conversion surgery and chemotherapy alone groups was compared using the log-rank test and Cox regression analysis after propensity score matching(PSM).Results: A nomogram with good discrimination(concordance index: 0.65) and accurate calibration was constructed. After PSM, the median survival time(MST) of conversion surgery was 26.80 months, compared with16.60 months of chemotherapy alone(P<0.001). Conversion surgery was associated with a longer MST for patients in the low-risk group(30.40 months vs. 20.90 months, P=0.013), whereas it was not associated with prolonged survival in the moderate-and high-risk groups(P=0.221 and P=0.131, respectively).Conclusions: Conversion surgery was associated with longer survival, especially for low-risk population.
Objective: Conversion surgery is a surgery with a purpose of R0 resection in primary advanced gastric cancer(GC) that responded well to systemic chemotherapy. This study aimed to explore the efficacy of conversion surgery for advanced GC.Methods: A total of 618 advanced GC patients receiving systemic chemotherapy were stratified into low-,moderate-and high-risk groups based on a nomogram-predicted probability of overall survival. The survival of conversion surgery and chemotherapy alone groups was compared using the log-rank test and Cox regression analysis after propensity score matching(PSM).Results: A nomogram with good discrimination(concordance index: 0.65) and accurate calibration was constructed. After PSM, the median survival time(MST) of conversion surgery was 26.80 months, compared with16.60 months of chemotherapy alone(P<0.001). Conversion surgery was associated with a longer MST for patients in the low-risk group(30.40 months vs. 20.90 months, P=0.013), whereas it was not associated with prolonged survival in the moderate-and high-risk groups(P=0.221 and P=0.131, respectively).Conclusions: Conversion surgery was associated with longer survival, especially for low-risk population.
Objective: Conversion surgery is a surgery with a purpose of R0 resection in primary advanced gastric cancer(GC) that responded well to systemic chemotherapy. This study aimed to explore the efficacy of conversion surgery for advanced GC.Methods: A total of 618 advanced GC patients receiving systemic chemotherapy were stratified into low-,moderate-and high-risk groups based on a nomogram-predicted probability of overall survival. The survival of conversion surgery and chemotherapy alone groups was compared using the log-rank test and Cox regression analysis after propensity score matching(PSM).Results: A nomogram with good discrimination(concordance index: 0.65) and accurate calibration was constructed. After PSM, the median survival time(MST) of conversion surgery was 26.80 months, compared with16.60 months of chemotherapy alone(P<0.001). Conversion surgery was associated with a longer MST for patients in the low-risk group(30.40 months vs. 20.90 months, P=0.013), whereas it was not associated with prolonged survival in the moderate-and high-risk groups(P=0.221 and P=0.131, respectively).Conclusions: Conversion surgery was associated with longer survival, especially for low-risk population.
引文
1.Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin 2015;65:87-108.
2.Gu X,Zheng R,Xia C,et al.Interactions between life expectancy and the incidence and mortality rates of cancer in China:a population-based cluster analysis.Cancer Commun(Lond)2018;38:44.
3.Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015.CA Cancer J Clin 2016;66:115-32.
4.Yang L,Zheng R,Wang N,et al.Incidence and mortality of stomach cancer in China,2014.Chin JCancer Res 2018;30:291-8.
5.Izuishi K,Mori H.Recent strategies for treating stage IV gastric cancer:Roles of palliative gastrectomy,chemotherapy,and radiotherapy.J Gastrointestin Liver Dis 2016;25:87-94.
6.Ohtsu A.Chemotherapy for metastatic gastric cancer:past,present,and future.J Gastroenterol 2008;43:256-64.
7.Koizumi W,Narahara H,Hara T,et al.S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer(SPIRITS trial):a phase IIItrial.Lancet Oncol 2008;9:215-21.
8.Bang YJ,Van Cutsem E,Feyereislova A,et al.Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer(ToGA):a phase 3,open-label,randomised controlled trial.Lancet 2010;376:687-97.
9.Van Cutsem E,Moiseyenko VM,Tjulandin S,et al.Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer:a report of the V325 Study Group.J Clin Oncol 2006;24:4991-7.
10.Okines AF,Ashley SE,Cunningham D,et al.Epirubicin,oxaliplatin,and capecitabine with or without panitumumab for advanced esophagogastric cancer:dose-finding study for the prospective multicenter,randomized,phase II/III REAL-3 trial.JClin Oncol 2010;28:3945-50.
11.Poston GJ,Adam R,Alberts S,et al.OncoSurge:a strategy for improving resectability with curative intent in metastatic colorectal cancer.J Clin Oncol2005;23:7125-34.
12.Adam R,Wicherts DA,de Haas RJ,et al.Patients with initially unresectable colorectal liver metastases:is there a possibility of cure?J Clin Oncol 2009;27:1829-35.
13.Okabe H,Ueda S,Obama K,et al.Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination.Ann Surg Oncol 2009;16:3227-36.
14.Kanda T,Yajima K,Kosugi S,et al.Gastrectomy as a secondary surgery for stage IV gastric cancer patients who underwent S-1-based chemotherapy:a multiinstitute retrospective study.Gastric Cancer 2012;15:235-44.
15.Kim SW.The result of conversion surgery in gastric cancer patients with peritoneal seeding.J Gastric Cancer 2014;14:266-70.
16.Wang Y,Yu YY,Li W,et al.A phase II trial of Xeloda and oxaliplatin(XELOX)neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis.Cancer Chemother Pharmacol 2014;73:1155-61.
17.Fukuchi M,Ishiguro T,Ogata K,et al.Risk factors for recurrence after curative conversion surgery for unresectable gastric cancer.Anticancer Res 2015;35:6183-7.
18.Fukuchi M,Ishiguro T,Ogata K,et al.Prognostic role of conversion surgery for unresectable gastric cancer.Ann Surg Oncol 2015;22:3618-24.
19.Kinoshita J,Fushida S,Tsukada T,et al.Efficacy of conversion gastrectomy following docetaxel,cisplatin,and S-1 therapy in potentially resectable stage IVgastric cancer.Eur J Surg Oncol 2015;41:1354-60.
20.Chan DY,Syn NL,Yap R,et al.Conversion surgery post-intraperitoneal paclitaxel and systemic chemotherapy for gastric cancer carcinomatosis peritonei.Are we ready?J Gastrointest Surg 2017;21:425-33.
21.Fukuchi M,Mochiki E,Ishiguro T,et al.Efficacy of conversion surgery following S-1 plus cisplatin or oxaliplatin chemotherapy for unresectable gastric cancer.Anticancer Res 2017;37:1343-7.
22.Sato Y,Ohnuma H,Nobuoka T,et al.Conversion therapy for inoperable advanced gastric cancer patients by docetaxel,cisplatin,and S-1(DCS)chemotherapy:a multi-institutional retrospective study.Gastric Cancer 2017;20:517-26.
23.Uemura N,Kikuchi S,Sato Y,et al.A phase II study of modified docetaxel,cisplatin,and S-1(mDCS)chemotherapy for unresectable advanced gastric cancer.Cancer Chemother Pharmacol 2017;80:707-13.
24.Yuan SQ,Nie RC,Chen S,et al.Selective gastric cancer patients with peritoneal seeding benefit from gastrectomy after palliative chemotherapy:a propensity score matching analysis.J Cancer2017;8:2231-7.
25.Yamaguchi K,Yoshida K,Tanahashi T,et al.The long-term survival of stage IV gastric cancer patients with conversion therapy.Gastric Cancer 2018;21:315-23.
26.Yoshida K,Yamaguchi K,Okumura N,et al.Is conversion therapy possible in stage IV gastric cancer:the proposal of new biological categories of classification.Gastric Cancer 2016;19:329-38.
27.Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4).Gastric Cancer 2017;20:1-19.
28.Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1).Eur J Cancer2009;45:228-47.
29.Harrell FE Jr.,Lee KL,Mark DB Multivariable prognostic models:issues in developing models,evaluating assumptions and adequacy,and measuring and reducing errors.Stat Med 1996;15:361-87.
30.Camp RL,Dolled-Filhart M,Rimm DL.X-tile:a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization.Clin Cancer Res 2004;10:7252-9.
31.Garrido MM,Kelley AS,Paris J,et al.Methods for constructing and assessing propensity scores.Health Serv Res 2014;49:1701-20.
32.Fujitani K,Yang HK,Mizusawa J,et al.Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor(REGATTA):a phase 3,randomised controlled trial.Lancet Oncol 2016;17:309-18.
33.Nie RC,Chen S,Yuan SQ,et al.Significant role of palliative gastrectomy in selective gastric cancer patients with peritoneal dissemination:A propensity score matching analysis.Ann Surg Oncol 2016;23:3956-63.
34.Yang XJ,Huang CQ,Suo T,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer:final results of a phase III randomized clinical trial.Ann Surg Oncol 2011;18:1575-81.
35.Sato Y,Takayama T,Sagawa T,et al.Phase II study of S-1,docetaxel and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer.Cancer Chemother Pharmacol 2010;66:721-8.
36.Cunningham D,Allum WH,Stenning SP,et al.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.N Engl J Med2006;355:11-20.
2.Gu X,Zheng R,Xia C,et al.Interactions between life expectancy and the incidence and mortality rates of cancer in China:a population-based cluster analysis.Cancer Commun(Lond)2018;38:44.
3.Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015.CA Cancer J Clin 2016;66:115-32.
4.Yang L,Zheng R,Wang N,et al.Incidence and mortality of stomach cancer in China,2014.Chin JCancer Res 2018;30:291-8.
5.Izuishi K,Mori H.Recent strategies for treating stage IV gastric cancer:Roles of palliative gastrectomy,chemotherapy,and radiotherapy.J Gastrointestin Liver Dis 2016;25:87-94.
6.Ohtsu A.Chemotherapy for metastatic gastric cancer:past,present,and future.J Gastroenterol 2008;43:256-64.
7.Koizumi W,Narahara H,Hara T,et al.S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer(SPIRITS trial):a phase IIItrial.Lancet Oncol 2008;9:215-21.
8.Bang YJ,Van Cutsem E,Feyereislova A,et al.Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer(ToGA):a phase 3,open-label,randomised controlled trial.Lancet 2010;376:687-97.
9.Van Cutsem E,Moiseyenko VM,Tjulandin S,et al.Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer:a report of the V325 Study Group.J Clin Oncol 2006;24:4991-7.
10.Okines AF,Ashley SE,Cunningham D,et al.Epirubicin,oxaliplatin,and capecitabine with or without panitumumab for advanced esophagogastric cancer:dose-finding study for the prospective multicenter,randomized,phase II/III REAL-3 trial.JClin Oncol 2010;28:3945-50.
11.Poston GJ,Adam R,Alberts S,et al.OncoSurge:a strategy for improving resectability with curative intent in metastatic colorectal cancer.J Clin Oncol2005;23:7125-34.
12.Adam R,Wicherts DA,de Haas RJ,et al.Patients with initially unresectable colorectal liver metastases:is there a possibility of cure?J Clin Oncol 2009;27:1829-35.
13.Okabe H,Ueda S,Obama K,et al.Induction chemotherapy with S-1 plus cisplatin followed by surgery for treatment of gastric cancer with peritoneal dissemination.Ann Surg Oncol 2009;16:3227-36.
14.Kanda T,Yajima K,Kosugi S,et al.Gastrectomy as a secondary surgery for stage IV gastric cancer patients who underwent S-1-based chemotherapy:a multiinstitute retrospective study.Gastric Cancer 2012;15:235-44.
15.Kim SW.The result of conversion surgery in gastric cancer patients with peritoneal seeding.J Gastric Cancer 2014;14:266-70.
16.Wang Y,Yu YY,Li W,et al.A phase II trial of Xeloda and oxaliplatin(XELOX)neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis.Cancer Chemother Pharmacol 2014;73:1155-61.
17.Fukuchi M,Ishiguro T,Ogata K,et al.Risk factors for recurrence after curative conversion surgery for unresectable gastric cancer.Anticancer Res 2015;35:6183-7.
18.Fukuchi M,Ishiguro T,Ogata K,et al.Prognostic role of conversion surgery for unresectable gastric cancer.Ann Surg Oncol 2015;22:3618-24.
19.Kinoshita J,Fushida S,Tsukada T,et al.Efficacy of conversion gastrectomy following docetaxel,cisplatin,and S-1 therapy in potentially resectable stage IVgastric cancer.Eur J Surg Oncol 2015;41:1354-60.
20.Chan DY,Syn NL,Yap R,et al.Conversion surgery post-intraperitoneal paclitaxel and systemic chemotherapy for gastric cancer carcinomatosis peritonei.Are we ready?J Gastrointest Surg 2017;21:425-33.
21.Fukuchi M,Mochiki E,Ishiguro T,et al.Efficacy of conversion surgery following S-1 plus cisplatin or oxaliplatin chemotherapy for unresectable gastric cancer.Anticancer Res 2017;37:1343-7.
22.Sato Y,Ohnuma H,Nobuoka T,et al.Conversion therapy for inoperable advanced gastric cancer patients by docetaxel,cisplatin,and S-1(DCS)chemotherapy:a multi-institutional retrospective study.Gastric Cancer 2017;20:517-26.
23.Uemura N,Kikuchi S,Sato Y,et al.A phase II study of modified docetaxel,cisplatin,and S-1(mDCS)chemotherapy for unresectable advanced gastric cancer.Cancer Chemother Pharmacol 2017;80:707-13.
24.Yuan SQ,Nie RC,Chen S,et al.Selective gastric cancer patients with peritoneal seeding benefit from gastrectomy after palliative chemotherapy:a propensity score matching analysis.J Cancer2017;8:2231-7.
25.Yamaguchi K,Yoshida K,Tanahashi T,et al.The long-term survival of stage IV gastric cancer patients with conversion therapy.Gastric Cancer 2018;21:315-23.
26.Yoshida K,Yamaguchi K,Okumura N,et al.Is conversion therapy possible in stage IV gastric cancer:the proposal of new biological categories of classification.Gastric Cancer 2016;19:329-38.
27.Japanese Gastric Cancer Association.Japanese gastric cancer treatment guidelines 2014(ver.4).Gastric Cancer 2017;20:1-19.
28.Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1).Eur J Cancer2009;45:228-47.
29.Harrell FE Jr.,Lee KL,Mark DB Multivariable prognostic models:issues in developing models,evaluating assumptions and adequacy,and measuring and reducing errors.Stat Med 1996;15:361-87.
30.Camp RL,Dolled-Filhart M,Rimm DL.X-tile:a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization.Clin Cancer Res 2004;10:7252-9.
31.Garrido MM,Kelley AS,Paris J,et al.Methods for constructing and assessing propensity scores.Health Serv Res 2014;49:1701-20.
32.Fujitani K,Yang HK,Mizusawa J,et al.Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor(REGATTA):a phase 3,randomised controlled trial.Lancet Oncol 2016;17:309-18.
33.Nie RC,Chen S,Yuan SQ,et al.Significant role of palliative gastrectomy in selective gastric cancer patients with peritoneal dissemination:A propensity score matching analysis.Ann Surg Oncol 2016;23:3956-63.
34.Yang XJ,Huang CQ,Suo T,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer:final results of a phase III randomized clinical trial.Ann Surg Oncol 2011;18:1575-81.
35.Sato Y,Takayama T,Sagawa T,et al.Phase II study of S-1,docetaxel and cisplatin combination chemotherapy in patients with unresectable metastatic gastric cancer.Cancer Chemother Pharmacol 2010;66:721-8.
36.Cunningham D,Allum WH,Stenning SP,et al.Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.N Engl J Med2006;355:11-20.