新辅助免疫化疗对比新辅助化疗用于局部进展期胃癌的临床疗效分析

王磊; 万凌红; 王涛; 覃中毅; 李凡; 刘文康; 王斌

doi:10.16016/j.2097-0927.202405076

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新辅助免疫化疗对比新辅助化疗用于局部进展期胃癌的临床疗效分析

临床医学 | 更新时间：2026-01-09

- 新辅助免疫化疗对比新辅助化疗用于局部进展期胃癌的临床疗效分析
- Clinical efficacy of neoadjuvant immunochemotherapy versus neoadjuvant chemotherapy for local advanced gastric adenocarcinoma
- 陆军军医大学学报 2024年46卷第20期页码：2313-2321
- 作者机构：
  
  1.400042 重庆，陆军军医大学(第三军医大学)陆军特色医学中心消化内科，消化系统肿瘤精准防治重庆市重点实验室
  2.213003 江苏常州，联勤保障部队第九○四医院常州医疗区
  3.400042 重庆，陆军军医大学(第三军医大学)陆军特色医学中心胃肠外科
- 作者简介：
  
  [王斌，E-mail: danielwang@tmmu.edu.cn WANG Bin, E-mail: danielwang@tmmu.edu.cn
- 基金信息：
  
  国家自然科学基金优秀青年科学项目(81822032);重庆市自然科学基金杰出青年项目(CSTC2019JCYJJQX0027);重庆市研究生科研创新项目(CYS22753);利益冲突所有作者声明不存在利益冲突
- DOI：10.16016/j.2097-0927.202405076
  中图分类号： R730.51;R730.53;R735.2
- 收稿：2024-05-20，
  
  修回：2024-07-25，
  
  纸质出版：2024-10-30
- 稿件说明：
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王磊, 万凌红, 王涛, 等. 新辅助免疫化疗对比新辅助化疗用于局部进展期胃癌的临床疗效分析[J]. 陆军军医大学学报, 2024,46(20):2313-2321.

Lei WANG, Linghong WAN, Tao WANG, et al. Clinical efficacy of neoadjuvant immunochemotherapy versus neoadjuvant chemotherapy for local advanced gastric adenocarcinoma[J]. Journal of Army Medical University, 2024, 46(20): 2313-2321.
王磊, 万凌红, 王涛, 等. 新辅助免疫化疗对比新辅助化疗用于局部进展期胃癌的临床疗效分析[J]. 陆军军医大学学报, 2024,46(20):2313-2321. DOI： 10.16016/j.2097-0927.202405076.

Lei WANG, Linghong WAN, Tao WANG, et al. Clinical efficacy of neoadjuvant immunochemotherapy versus neoadjuvant chemotherapy for local advanced gastric adenocarcinoma[J]. Journal of Army Medical University, 2024, 46(20): 2313-2321. DOI： 10.16016/j.2097-0927.202405076.

摘要

目的

分析新辅助免疫化疗(neoadjuvant immunochemotherapy，NAIC)和新辅助化疗(neoadjuvant chemotherapy，NAC)用于局部进展期胃癌的临床疗效，探究疗效相关临床病理特征。

方法

本研究采用回顾性队列研究设计方案，收集2017年1月至2023年7月陆军特色医学中心(大坪医院)和中国医科大学第一附属医院共243例局部进展期胃癌患者的临床资料，通过纳入排除标准和倾向性评分匹配(propensity score matching，PSM)均衡2组间混杂因素后，分析2种新辅助治疗方案的肿瘤病理缓解率和安全性，并对临床病理特征进行亚组分析寻找与疗效相关的临床病理特征。

结果

对两组患者采用PSM平衡两组基线特征后，每组各53名受试者纳入分析。在肿瘤病理退缩方面，NAIC组(13名

25%)的病理完全缓解(pathologic complete response

pCR)率显著高于NAC组(2名

3.8%，

＜0.05)。在主要病理学缓解(major pathological response，MPR)方面也观察到类似的结果，NAIC组有23名(43%)患者实现了MPR，而NAC组有9名(17%)患者实现MPR(

＜0.05)。安全性方面，NAIC组和NAC组的任何等级TRAEs发生率相当(分别为96.2%和96.2%)。基于肿瘤病理退缩的探索性亚组分析发现，符合年龄＜65岁、男性、AJCC分期的Ⅲ~ⅣA期、腺癌、高-中分化、肠型胃癌、T分期的T3~T4分期和N分期的N2~N3分期等临床病理特征的胃癌患者，更可能获益于新辅助免疫化疗。

结论

局部进展期胃癌接受新辅助免疫化疗的病理学缓解率优于新辅助化疗，不良反应发生率相当。

Abstract

Objective

To evaluate the therapeutic efficacies of neoadjuvant immunochemotherapy (NAIC) and neoadjuvant chemotherapy (NAC) for local advanced gastric adenocarcinoma and analyze the clinicopathological characteristics.

Methods

A retrospective cohort study was conducted on 243 patients with locally advanced gastric cancer admitted in Army Medical Center of PLA (Daping Hospital) and the First Affiliated Hospital of China Medical University from January 2017 to July 2023. After balancing the confounding factors by inclusion and exclusion criteria and propensity score matching (PSM)

the tumor pathological regression (TRG) rate and safety of the 2 neoadjuvant treatment regimens were analyzed

and the clinical pathological characteristics were analyzed to find clinical pathological characteristics related to efficacy.

Results

After using PSM to balance the baseline characteristics of the 2 groups of patients

53 subjects in each group were included in the analysis. In terms of TRG

the pathological complete response (pCR) rate in the NAIC group (13 patients

25%) was significantly higher than that in the NAC group (2 patients

3.8%

0.05). Similar results were observed in terms of major pathological response (MPR)

with 23 patients (43%) in the NAIC group achieving MPR

while 9 patients (17%) in the NAC group achieved MPR (

0.05). In terms of safety

the incidence of treatment-related adverse events(TRAEs) of any grade in the NAIC group and the NAC group was comparable (96.2% and 96.2%

respectively). In an exploratory subgroup analysis of tumor pathological regression

the patients with clinicopathological features such as age

65 years

male

stage Ⅲ~ⅣA of American Joint Committee on Cancer (AJCC) staging

histological type of adenocarcinoma

high-moderate differentiated

intestinal-type gastric cancer

stage T3~4 of clinical T-staging

and stage N2~3 of clinical N-staging were more likely to benefit from NAIC.

Conclusion

NAIC results in a higher rate of pathological regression and a comparable incidence of adverse events when compared with chemotherapy alone for patients with local advanced gastric adenocarcinoma.

关键词

Keywords

references

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