Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across d...Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across diverse patient populations and treatment settings.This study aimed to assess the outcomes of LDG vs.open distal gastrectomy(ODG)in patients with LAGC despite differences in clinical trial populations and treatment environments.Methods:The KLASS-02 and CLASS-01 trials are multicenter,non-inferiority,open-label,randomized controlled trials for patients with LAGC eligible for distal subtotal gastrectomy in Korea and China,respectively.Some 1,050 patients were enrolled in KLASS-02,and 1,056 patients were enrolled in CLASS-01.Individual patient data(IPD)from KLASS-02 and CLASS-01 were pooled and analyzed.Results:There were 900 patients in the LDG group and 920 in the ODG group.Baseline characteristics were well balanced between groups.The LDG group had better short-term and recovery outcomes than the ODG group,although anastomotic leakage was more frequent.For patients who underwent LDG vs.ODG,5-year overall survival(OS)was 82.7%[95%confidence interval(95%CI),80.2%-85.2%]vs.83.3%(95%CI,80.9%-85.8%)(P=0.706)and 5-year recurrence-free survival(RFS)was 76.9%(95%CI,74.1%-79.7%)vs.77.9%(95%CI,75.2%-80.6%)(P=0.666),respectively,with a median follow-up of 70 months.In the multivariable prognostic IPD meta-analysis,the operative approach was not independently associated with OS[hazard ratio(HR)=1.045,95%CI,0.833-1.311;P=0.706]or RFS(HR=1.044,95%CI,0.859-1.269;P=0.667)for LDG vs.ODG.In the subgroup analysis,LDG demonstrated a significant association with poorer RFS in the p T4 subgroup(HR=1.377,95%CI,1.022-1.760;P=0.034).Conclusions:Despite differences in patient populations,surgical practices,and postoperative treatments between trials,LDG is oncologically safe with the benefit of being minimally invasive for patients with LAGC,except for the p T4 patients.Therefore,LDG could be a good treatment alternative for patients with LAGC;however,caution should be warranted in its application for patients classified as T4.展开更多
To the Editor:Primary liver cancer is one of the most common malignant tumors in China.In 2020,410,038 new cases of liver cancer and 391,152 deaths due to liver cancer were reported in China,which places liver cancer ...To the Editor:Primary liver cancer is one of the most common malignant tumors in China.In 2020,410,038 new cases of liver cancer and 391,152 deaths due to liver cancer were reported in China,which places liver cancer as the second most common cancer-related cause of death in China;of these cancers,hepatocellular carcinoma(HCC)accounts for 85-90%.[1]HCC poses a significant threat to the lives and health of Chinese people.展开更多
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the 2024 intramural research fund of Ajou University Medical Center(No.M-2024-C0460-00083)+3 种基金an Investigator-Initiated Study granted from Ethicon,Inc-Johnson and Johnson Med Tech(No.ENG-2021-04)the Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer(No.2020B121201004)Guangdong Provincial Major Talents Project(No.2019JC05Y361)Major Clinical Technology Project in Guangzhou(No.2023P-ZD01)。
文摘Objective:Laparoscopic distal gastrectomy(LDG)has potential as a surgical treatment option for locally advanced gastric cancer(LAGC).However,there is uncertainty regarding the generalizability of LDG efficacy across diverse patient populations and treatment settings.This study aimed to assess the outcomes of LDG vs.open distal gastrectomy(ODG)in patients with LAGC despite differences in clinical trial populations and treatment environments.Methods:The KLASS-02 and CLASS-01 trials are multicenter,non-inferiority,open-label,randomized controlled trials for patients with LAGC eligible for distal subtotal gastrectomy in Korea and China,respectively.Some 1,050 patients were enrolled in KLASS-02,and 1,056 patients were enrolled in CLASS-01.Individual patient data(IPD)from KLASS-02 and CLASS-01 were pooled and analyzed.Results:There were 900 patients in the LDG group and 920 in the ODG group.Baseline characteristics were well balanced between groups.The LDG group had better short-term and recovery outcomes than the ODG group,although anastomotic leakage was more frequent.For patients who underwent LDG vs.ODG,5-year overall survival(OS)was 82.7%[95%confidence interval(95%CI),80.2%-85.2%]vs.83.3%(95%CI,80.9%-85.8%)(P=0.706)and 5-year recurrence-free survival(RFS)was 76.9%(95%CI,74.1%-79.7%)vs.77.9%(95%CI,75.2%-80.6%)(P=0.666),respectively,with a median follow-up of 70 months.In the multivariable prognostic IPD meta-analysis,the operative approach was not independently associated with OS[hazard ratio(HR)=1.045,95%CI,0.833-1.311;P=0.706]or RFS(HR=1.044,95%CI,0.859-1.269;P=0.667)for LDG vs.ODG.In the subgroup analysis,LDG demonstrated a significant association with poorer RFS in the p T4 subgroup(HR=1.377,95%CI,1.022-1.760;P=0.034).Conclusions:Despite differences in patient populations,surgical practices,and postoperative treatments between trials,LDG is oncologically safe with the benefit of being minimally invasive for patients with LAGC,except for the p T4 patients.Therefore,LDG could be a good treatment alternative for patients with LAGC;however,caution should be warranted in its application for patients classified as T4.
基金supported by grants from the State Key Project of the National Natural Science Foundation of China(No.81730097)the Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center(Joint Project of Emerging Frontier Technology)(No.SHDC12018116)the Clinical Research Plan of Shanghai Hospital Development Center(No.SHDC2020CR1004A).
文摘To the Editor:Primary liver cancer is one of the most common malignant tumors in China.In 2020,410,038 new cases of liver cancer and 391,152 deaths due to liver cancer were reported in China,which places liver cancer as the second most common cancer-related cause of death in China;of these cancers,hepatocellular carcinoma(HCC)accounts for 85-90%.[1]HCC poses a significant threat to the lives and health of Chinese people.
