Zhongguo aizheng zazhi (Sep 2022)
Prognostic significance of adjuvant chemotherapy in patients with gastric neuroendocrine carcinoma
Abstract
Background and purpose: Gastric neuroendocrine neoplasm (NEN) is a rare type of gastric malignant tumors. According to the 2019 World Health Organization (WHO) classification criteria for gastrointestinal NEN, gastric NEN can be divided into well-differentiated neuroendocrine tumor (NET) and poorly-differentiated neuroendocrine carcinoma (NEC). At present, there is a lack of research on the prognosis of adjuvant chemotherapy for gastric NEC (GNEC). The aim of the research was to investigate whether adjuvant chemotherapy can benefit patients with GNEC and provide a basis for clinical decision-making. Methods: A retrospective analysis was performed on the clinical data of about 184 patients with GNEC from July 2008 to June 2019 in Sun Yat-sen University Cancer Center, The First Affiliated Hospital of Sun Yat-sen University and Fudan University Shanghai Cancer Center. The follow-up deadline was May 31, 2022. Kaplan-Meier method was used to draw the survival curve, and prognostic relevant factors affecting the survival of patients with GNEC and the independent prognostic factors were screened out according to univariate and multivariate COX regression analyses. Finally, the effects of chemotherapy and surgery on the prognosis of patients were further analyzed. The test level was α = 0.05, and SPSS 25.0 was used for all statistical analyses. Results: By univariate COX regression analysis, it was found that surgery, chemotherapy, treatment method, N stage, M stage and TNM stage were the variables affecting the prognosis of patients with GNEC (P<0.05). Multivariable COX regression analysis results showed that surgery, chemotherapy and M stage were independent prognostic factors for survival in patients with GNEC (P<0.001). The 3-year cumulative survival rates of TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 51.9%, 55.8%, 40.7% and 23.6%, respectively. In the radical resection group, adjuvant chemotherapy could improve the prognosis of patients with GNEC (P=0.008). The 3-year cumulative survival rates of adjuvant chemotherapy group and non-adjuvant chemotherapy group were 58.8% and 33.3%, respectively. Stratified analysis showed that adjuvant chemotherapy could benefit the prognosis of patients with TNM stage Ⅱ (P = 0.018) and TNM stage Ⅲ (P = 0.023). In addition, there was no significant difference in prognosis between the first-line chemotherapy regimen [etoposide plus cisplatin (EP), irinotecan plus cisplatin (IP)] and the gastric adenocarcinoma regimen [oxaliplatin plus capecitabine (XELOX), oxaliplatin plus tegafur (SOX), oxaliplatin plus 5-fluorouracil (FOLFOX)] (P = 0.668). Conclusion: Adjuvant chemotherapy can significantly improve the prognosis of patients with GNEC, providing a reference for clinical decision-making.
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