关键词: 胃肿瘤, 药物疗法, 组织学, 比较, 预后

Abstract: Objective  To discuss the correlation between histological evaluation of primary lesions and prognosis of gastric cancer patients treated with neoadjuvant chemotherapy. MethodsA total of 117 patients with stage Ⅱ-Ⅲ gastric cancer who received neoadjuvant chemotherapy in our hospital from January 2006 to December 2012 were enrolled. All patients received 2 courses of neoadjuvant chemotherapy and underwent CT, gastrointestinal radiography or endoscopic examination to evaluate the response to neoadjuvant chemotherapy, and the histochemical staining results of the surgical specimens were also used for chemotherapy responsive validation. Kappa (κ) coefficient was used to analyzed the consistency of different evaluation methods for chemotherapy reactivity. The 5year survival rate was used for compared the effective assessments in three different approaches. ResultsThere were 38 cases (32.5%), 78 cases (66.7%) and 43 cases (36.8%) were considered to be CT, gastrointestinal radiography or endoscopic examination and histologic responders, respectively. Histological evaluation of primary lesions was less correlated with CT, gastrointestinal radiography or endoscopic evaluation (κ values were 0.10 and 0.19 respectively).  Based on CT evaluation, the median survival time of patients with chemotherapy response was longer than 60 months, and the median survival time of patients without response was 43 months, and the difference was not statistically significant (χ2=2.978, P=0.076). Based on gastrointestinal radiography or endoscopy evaluation, the median survival time of patients with chemotherapy response was longer than 60 months, and the median survival time of patients without response was 29 months, and the difference was not statistically significant (χ2=1.230, P=0.239). Based on histological evaluation, the median survival time of patients with chemotherapy response was longer than 60 months, and the median survival time of patients without response was 18.5 months, and the difference was statistically significant (χ2=29.020, P<0.001).  Multivariate Cox regression analysis showed that nonrespond of adjuvant chemotherapy under histologic evaluation (HR=4.021, 95%CI: 1.5488.767, P=0.002) and nonrespond of  gastrointestinal radiography or endoscopic examination (HR=8.210, 95%CI: 4.333-17.980, P<0.001) were independent risk factors for poor prognosis in patients with gastric cancer, and intestinal gastric cancer (HR=0.241, 95%CI: 0.080-0.871, P=0.019) was an independent predictor of survival improvement in patients with gastric cancer. Conclusion The degree of neoadjuvant chemotherapy response assessed by histological evaluation of primary lesions can effectively predict the longterm survival outcomes for gastric cancer patients.

Key words: Stomach neoplasms, Drug therapy, Histology, comparative, Prognosis