| Objective:We retrospectively studied the data of gastric cancer patients in Qingdao area after neoadjuvant chemotherapy to evaluate the applicability of AJCC version 8 ypTNM staging system,and analyzed the factors affecting the prognosis of gastric cancer patients after neoadjuvant chemotherapy.Methods:We performed a retrospective survival analysis of gastric cancer patients who received neoadjuvant chemotherapy in Qingdao Municipal Hospital and affiliated hospital of Qingdao University from January 2009 to January 2017.Results:A total of 158 patients were included in this study,including 112 males(70.9%)and 46 females(29.1%).The average age was 61.4(40-82).The median number of total lymph node resection was 24(15-73),and the median number of metastatic lymph nodes was 2(0-56).The median tumor diameter was 4.0cm(0-17cm,major axis),and 3.0cm(0-10cm,minor axis).The median follow-up time was 36 months(8-96 months),and 87 patients died at the last follow-up.The 3-year and 5-year overall survival(OS)rates were 51.9%and 47.1%,respectively.The 3-year and 5-year disease-free survival(DFS)rates were 43.7%and 38.5%.8 patients achieved pathological complete response(pCR).Besides,there were 20 stage I cases,42 stage II cases,and 88 stage III cases.The pCR cases had similar survival rates compared to stage I patients(p>0.05).The 3-year disease-free survival(DFS)rates and 5-year overall survival(OS)rates of stage I,II and III patients were significantly different(3-year DFS:85.0,54.8,and 23.9%,p<0.001;5-year OS:79.7,59.1,and 20.0%,p=0.001)We found that age,BMI,pathological type,ypT staging and ypN staging were important factors affecting the prognosis of gastric cancer patients in the multifactorial analysis.The OS and DFS rates of ypT4b and ypN3 patients are lower than the rest of stage ? patients(p=0.004,p=0.001).OS(p<0.001)and DFS(p<0.001)rates were significantly different between stage ?,stage ?,stage ?A and stage ?B after subgroup analysis.Three years DFS rate were 85.0%,54.8%,36.8%,14.0%(chi-square=46.47,p<0.001),5 years OS rate were 79.7%,59.1%,41.0%,9.5%(chi-square=45.29,p<0.001).Multivariate Cox regression analysis found that age(HR=1.07(1.03-1.10)),BMI(BMI 18.5-25.0 HR=0.37(0.19-0.72);BMI 25.0-30.0 HR=0.29(0.15-0.57)),Lauren typing(Diffuse type HR=5.15(2.58-10.29);Mixed type HR=3.74(1.76-7.94)),ypT staging(ypT4A HR=3.40(1.01-11.47);ypT4B HR=8.34(2.36-29-49))and ypN staging(ypN2 HR=3.65(1.65-8.08);ypN3 HR=7.77(3.78-15.94))were important factors affecting OS in gastric cancer patients.Age(HR=1.06(1.03-1.10)),BMI(BMI 18.5-25.0 HR=0.33(0.17-0.66);BMI 25.0-30.0 HR=0.23(0.12-0.47)),pathological type(Diffuse type HR=5.15(2.58-10.29);Mixed type HR=3.74(1.76-7.94)),ypT stage(ypT4B HR=6.05(1.67-21.96))and ypN stage(ypN2 HR=2.85(1.28-6.35);ypN3 HR=7.63(3.65-15.94))were significantly correlated with DFS.Conclusions:We found that the eighth edition of AJCC ypTNM staging system was not ideal for the stratification of prognosis of gastric cancer patients in Qingdao area,and further improvement was needed.Age,BMI,Lauren classification,ypT and ypN were independent risk factors for prognosis of gastric cancer patients after neoadjuvant chemotherapy. |
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