Objectives: To analyze the long-term prognosis of patients with locally advanced gastric cancer in the stage of ypT0~2N0M0 after neoadjuvant chemotherapy. Methods: The clinical data of 78 patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy and radical resection at ypT0~2N0M0 stage from January 2012 to December 2019 in the Department of Abdominal Surgery/Pancreatic and Gastric Surgery of the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival and disease-free survival, and the survival difference between patients with postoperative ypT0N0M0 and ypT1~2N0M0 was compared. Multivariate Cox proportional hazards regression analysis was performed on clinical, pathologic and treatment measures that may affect survival. Results: Among the 78 patients, there were 18 cases (23.1%) with ypT0N0M0, 14 cases (17.9%) with ypT1aN0M0, 17 cases (21.8%) with ypT1bN0M0, and 29 cases (37.2%) with ypT2N0M0. Median follow-up time was 74.1 (19.8~132.5) months. Fourteen patients (17.9%) had tumor recurrence and metastasis, and 9 patients died from tumor recurrence and metastasis. The 5-year disease-free survival and overall survival rates were 84.4% and 87.8%, respectively. There was no statistically significant difference in 5-year overall survival (86.9% vs 87.8%) or 5-year disease-free survival (88.9% vs 83.2%) between patients with ypT0N0M0 and ypT1~2N0M0. Analysis of factors that may affect prognosis revealed that signet ring cell carcinoma, nerve invasion, and lymph node dissection of fewer than 16 were significantly associated with prognosis (P＜0.05). Multivariate Cox analysis including these three factors showed that only lymph node dissection of fewer than 16 was an independent risk factor affecting prognosis (OS: HR=10.44 ,95% CI: 2.15-50.72, P=0.004; DFS: HR=11.47, 95% CI: 2.85-46.20, P=0.001). Conclusions: The long-term prognosis of patients with locally advanced gastric cancer at ypT0~2N0M0 stage after neoadjuvant chemotherapy is relatively good, and the long-term survival time of patients with ypT1~2N0M0 and ypT0N0M0 is similar. Lymph node dissection of less than 16 nodes may be an independent risk factor affecting prognosis. During surgery, efforts should be made to increase the number of lymph node dissections. For patients with less than 16 nodes dissected, postoperative treatment and follow-up should be strengthened.
目的： 分析经新辅助化疗后ypT0～2N0M0期局部进展期胃癌患者的长期预后。 方法： 回顾性分析2012年1月至2019年12月中国医学科学院肿瘤医院收治的经新辅助化疗后行根治性切除手术分期为ypT0～2N0M0期的78例局部进展期胃癌患者的临床资料，生存分析采用Kaplan-Meier 法和Log rank检验，影响因素分析采用 Cox 比例风险模型。 结果： 78例患者中，ypT0N0M0期18例，ypT1aN0M0期14例，ypT1bN0M0期17例，ypT2N0M0期29例。中位随访74.1个月（19.8～132.5个月），78例患者中出现复发转移14例，死于肿瘤复发转移9例。全组患者的5年无病生存率和5年总生存率分别为84.4%和87.8%。ypT0N0M0与ypT1～2N0M0期患者的5年总生存率（分别为86.9%和87.8%）及5年无病生存率（分别为88.9%和83.2%）差异均无统计学意义（均P＞0.05）。印戒细胞癌、神经侵犯、淋巴结清扫＜16枚与预后有关（均P＜0.05）。多因素因素分析显示，淋巴结清扫＜16枚是影响预后的独立危险因素（总生存：HR=10.44，95% CI：2.15～50.72，P=0.004；无病生存：HR=11.47，95% CI：2.85～46.20，P=0.001）。 结论： 经新辅助化疗后，ypT0～2N0M0期局进展期胃癌患者的长期预后相对较好，且ypT1～2N0M0 与ypT0N0M0期患者的长期生存时间相近。淋巴结清扫＜16枚可能是影响预后的独立危险因素，术中应尽量增加淋巴结清扫数目，针对清扫淋巴结数＜16枚的患者需加强术后治疗和随访。.