1
|
Gao X, Li G, Deng J, Zhao L, Han W, Zhang N, Gao Y, Lu L, Wang S, Yu J, Yan J, Zhang G, Peng R, Zhang R, Fu Y, He F, Hu J, Wang W, Fan P, Si C, Gao P, Liang H, Chen H, Ji G, Shang L, Zhao Q, Zhang Z, Yang S, Wang Z, Xi H, Chen Y, Wu K, Nie Y. Association of survival with adjuvant chemotherapy in patients with stage IB gastric cancer: a multicentre, observational, cohort study. Lancet Reg Health West Pac 2024; 45:101031. [PMID: 38361774 PMCID: PMC10867760 DOI: 10.1016/j.lanwpc.2024.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
Background Recurrence following radical resection in patients with stage IB gastric cancer (GC) is not uncommon. However, whether postoperative adjuvant chemotherapy could reduce the risk of recurrence in stage IB GC remains contentious. Methods We collected data on 2110 consecutive patients with pathologic stage IB (T1N1M0 or T2N0M0) GC who were admitted to 8 hospitals in China from 2009 to 2018. The survival of patients who received adjuvant chemotherapy was compared with that of postoperative observation patients using propensity score matching (PSM). Two survival prediction models were constructed to estimate the predicted net survival gain attributable to adjuvant chemotherapy. Findings Of the 2110 patients, 1344 received adjuvant chemotherapy and 766 received postoperative observation. Following the 1-to-1 matching, PSM yielded 637 matched pairs. Among matched pairs, adjuvant chemotherapy was not associated with improved survival compared with postoperative observation (OS: hazard ratio [HR], 0.72; 95% CI, 0.52-1.00; DFS: HR, 0.91; 95% CI, 0.64-1.29). Interestingly, in the subgroup analysis, reduced mortality after adjuvant chemotherapy was observed in the subgroups with elevated serum CA19-9 (HR, 0.22; 95% CI, 0.08-0.57; P = 0.001 for multiplicative interaction), positive lymphovascular invasion (HR, 0.32; 95% CI, 0.17-0.62; P < 0.001 for multiplicative interaction), or positive lymph nodes (HR, 0.17; 95% CI, 0.07-0.38; P < 0.001 for multiplicative interaction). The survival prediction models mainly based on variables associated with chemotherapy benefits in the subgroup analysis demonstrated good calibration and discrimination, with relatively high C-indexes. The C-indexes for OS were 0.74 for patients treated with adjuvant chemotherapy and 0.70 for patients treated with postoperative observation. Two nomograms were built from the models that can calculate individualized estimates of expected net survival gain attributable to adjuvant chemotherapy. Interpretation In this cohort study, pathologic stage IB alone was not associated with survival benefits from adjuvant chemotherapy compared with postoperative observation in patients with early-stage GC. High-risk clinicopathologic features should be considered simultaneously when evaluating patients with stage IB GC for adjuvant chemotherapy. Funding National Natural Science Foundation of China; the National Key R&D Program of China.
Collapse
Affiliation(s)
- Xianchun Gao
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Gang Li
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting, Nanjing 210009, China
| | - Jingyu Deng
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, West Huanhu Road, Tianjin 300060, China
| | - Lulu Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Weili Han
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Nannan Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Yunhe Gao
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing, Beijing 100853, China
| | - Linbin Lu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Shibo Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Jun Yu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Junya Yan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Gan Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing, Beijing 100853, China
| | - Rui Peng
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting, Nanjing 210009, China
| | - Rupeng Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, West Huanhu Road, Tianjin 300060, China
| | - Yu Fu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, 155 North Nanjing Street, Shenyang, 110001, China
| | - Fang He
- Department of Gastroenterology, General Hospital of Ningxia Medical University, 804 Shengli, Yinchuan 750004, China
| | - Junguo Hu
- Gansu Wuwei Cancer Hospital, 16 Xuanwu, Wuwei 733000, China
| | - Wanqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Ping Fan
- Gansu Wuwei Cancer Hospital, 16 Xuanwu, Wuwei 733000, China
| | - Cen Si
- Department of Gastroenterology, General Hospital of Ningxia Medical University, 804 Shengli, Yinchuan 750004, China
| | - Peng Gao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, 155 North Nanjing Street, Shenyang, 110001, China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Cancer for Cancer, West Huanhu Road, Tianjin 300060, China
| | - Huanqiu Chen
- Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & the Affiliated Cancer Hospital of Nanjing Medical University, 42 Baiziting, Nanjing 210009, China
| | - Gang Ji
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Lei Shang
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Qingchuan Zhao
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Zhiyi Zhang
- Gansu Wuwei Cancer Hospital, 16 Xuanwu, Wuwei 733000, China
| | - Shaoqi Yang
- Department of Gastroenterology, General Hospital of Ningxia Medical University, 804 Shengli, Yinchuan 750004, China
| | - Zhenning Wang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, 155 North Nanjing Street, Shenyang, 110001, China
| | - Hongqing Xi
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing, Beijing 100853, China
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China
| | - Kaichun Wu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| | - Yongzhan Nie
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, China
| |
Collapse
|
11
|
Si C, Tian G, Wu S. [A study on the effects of three kinds of treatment in chronic hepatitis B]. Zhonghua Nei Ke Za Zhi 1997; 36:661-4. [PMID: 10436979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
To study the effects of three kinds of treatment: Zhuling polysaccharides combined with hepatitis B vaccine (group I), LAK cells, induced by interleukin-2 (IL-2) in vitro, transfusion therapy, (group II), bacille Calmette-Guerin (BCG) combined with persatin (group III) in chronic hepatitis B and the mechanism of their effects, we observed 286 patients with chronic hepatitis B, diagnosed according to the criteria made by The 6th National Meeting for Viral Hepatitis and Substantiated by the results of liver biopsy. The patients were divided into 3 treatment groups randomly, with interferon 3 MIU, thrice a week and 10% glucose 500 ml (i.v.) dripping everyday as two different control groups. The ALT recovery rates in group I, II, III were 64%, 35% and 57%, respectively. At the end of the treatment, the HBeAg and HBV DNA clearence rates in group I, II, III were 43% and 44%, 34% and 30%, 57% and 61%, respectively. After one year of follow up, the HBeAg and HBV DNA clearence rates in group I, II, III were 59%, 58%, 61% and 55%, 70%, 60%, respectively. The effects of these kinds of treatment were similar to these of interferon. We also injected Zhuling polysaccharides combined with hepatitis B vaccine, Zhuling polysaccharides alone and normal saline as control to DHBV vertical transmission duck. It was shown that serum DHBV DNA was cleared and the results were also proved by liver histologic change in the two treatment groups. According to these data, it is suggested that the three kinds of treatment for hepatitis B could restore the ALT level, suppress the replication of HBV and improve the liver histologic change. Their effects were similar to those of interferon.
Collapse
Affiliation(s)
- C Si
- First Teaching Hospital, Beijing Medical University
| | | | | |
Collapse
|