基本信息
文件名称:最新NCCN胃癌临床实践指南更新要点PPT课件.ppt
文件大小:1.85 MB
总页数:28 页
更新时间:2025-07-04
总字数:约5.71万字
文档摘要

*PhaseIIIComparisonofPreoperativeChemotherapyComparedWithChemoradiotherapyinPatientsWithLocallyAdvancedAdenocarcinomaoftheEsophagogastricJunctionPurposePreoperativechemotherapyisanacceptedstandardinthetreatmentoflocalizedesophagogastricadenocarcinoma.Addingradiationtherapytopreoperativechemotherapyappearspromising,butitsde?nitivevalueremainsunknown.PatientsandMethodsPatientswithlocallyadvanced(uT3-4NXM0)adenocarcinomaoftheloweresophagusorgastriccardiawererandomlyallocatedtooneoftwotreatmentgroups:inductionchemother-apy(15weeks)followedbysurgery(armA);orchemotherapy(12weeks)followedbychemoradiotherapy(3weeks)followedbysurgery(armB).Primaryoutcomewasoverallsurvivaltime.Atotalof354patientswereneededtodetecta10%increasein3-yearsurvivalfrom25%to35%byadditionofradiationtherapy.Thestudywasprematurelyclosedduetolowaccrual.ResultsThemedianobservationtimewas46months.Atotalof126patientswererandomlyassignedand119eligiblepatientswereevaluated.Thenumberofpatientsundergoingcompletetumorresectionwasnotdifferentbetweentreatmentgroups(69.5%v71.5%).PatientsinarmBhadasigni?canthigherprobabilityofshowingpathologiccompleteresponse(15.6%v2.0%)ortumor-freelymphnodes(64.4%v37.7%)atresection.Preoperativeradiationtherapyimproved3-yearsurvivalratefrom27.7%to47.4%(log-rankP?.07,hazardratioadjustedforrandomizationstratavariables0.67,95%CI,0.41to1.07).Postoperativemortalitywasnonsigni?cantlyincreasedinthechemoradiotherapygroup(10.2%v3.8%;P?.26).ConclusionAlthoughthestudywasclosedearlyandstatisticalsigni?cancewasnotachieved,resultspointtoasurvivaladvantageforpreoperativechemoradiotherapycomparedwithpreoperativechemother-apyinadenocarcinomasoftheesophagogastricjunction.*