This retrospective study examined early the predictive factors for successful conversion surgery (CS) with R0 resection in patients with metastatic gastric cancer (MGC) who underwent systemic chemotherapy. This study included 204 patients diagnosed with metastatic gastric adenocarcinoma, who received chemotherapy between 2009 and 2019. Of these patients, 31 (15%) underwent CS with R0 resection. The incidence of CS with R0 resection was not affected by the volume of metastatic lesions or the presence of peritoneal metastasis. The overall survival time of the CS with R0 resection group was significantly longer than that of the non-CS group (hazard ratio, 0.12; 95% confidence interval, 0.07–0.23;p< 0.0001), with a 5 year overall survival rate of 50.2%. Multivariate analysis of 150 patients, excluding those with disease progression until the initial Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, showed that carcinoembryonic antigen > 5.0 ng/mL at the initial RECIST evaluation was an independent, significant, and unfavorable predictor of CS with R0 resection (odds ratio, 0.21;p= 0.0108), whereas systemic chemotherapy with trastuzumab for HER2-positive cancer was a favorable factor (odds ratio, 4.20;p= 0.0119). Monitoring serum carcinoembryonic antigen levels during chemotherapy may be a useful predictor of the CS implementation in patients with MGC.
本回顾性研究旨在探讨转移性胃癌患者在接受全身化疗后，成功实施R0切除转化手术的早期预测因素。研究纳入了2009年至2019年间确诊为转移性胃腺癌并接受化疗的204例患者，其中31例（15%）接受了R0切除转化手术。转移病灶的数量或腹膜转移的存在并不影响R0切除转化手术的实施率。接受R0切除转化手术的患者总生存时间显著长于未接受该手术的患者（风险比为0.12；95%置信区间为0.07–0.23；p<0.0001），其5年总生存率达到50.2%。在排除疾病进展至首次实体瘤疗效评价标准评估的54例患者后，对150例患者进行的多变量分析显示，首次实体瘤疗效评价标准评估时癌胚抗原水平>5.0 ng/mL是R0切除转化手术的独立、显著且不利的预测因素（比值比为0.21；p=0.0108），而针对HER2阳性癌症使用曲妥珠单抗进行全身化疗则是有利因素（比值比为4.20；p=0.0119）。化疗期间监测血清癌胚抗原水平可能成为预测转移性胃癌患者能否实施转化手术的有效指标。
肿瘤(癌症)患者之家