Ⅲ期胃癌术后辅助化疗所致中性粒细胞减少出现时间与患者预后的关系

目的分析Ⅲ期胃癌术后辅助化疗所致中性粒细胞减少(CIN)出现时间与患者预后的关系。方法回顾性分析210例行Ⅲ期胃癌D2根治术并接受含奥沙利铂或多西他赛辅助化疗至少2周期患者的临床资料,其中CIN发生于化疗第1~3周期101例(早期组),发生于化疗第4~6周期109例(晚期组),比较两组无病生存期(DFS)及总生存期(OS)。结果早期组DFS为16.3个月、OS为36.6个月,晚期组分别12.0、28.0个月,P均<0.05。COX多因素分析结果显示,CIN时间是影响胃癌术后患者的独立预后因子。结论Ⅲ期胃癌术后患者化疗早出现CIN者预后优于晚出现者,监测CIN出现时间有利于进行早期预后评估及调整化疗药物剂量。     

胃癌根治术患者术后早期复发转移的相关危险因素

目的探讨影响胃癌根治术后早期复发转移的相关危险因素。方法对139例胃癌根治术患者随访2年,2年内依据是否复发分为复发转移组64例和未复发转移组75例,采用单因素、多因素分析方法来筛选早期复发转移的相关危险因素。结果胃癌根治术后早期复发率为46.0%(64/139);多因素分析结果显示,肿瘤最大直径(OR=3.764)、TNM分期(OR=3.370)、浆膜浸润(OR=8.322)、淋巴结转移(OR=5.219)、阳性淋巴结数(OR=3.226)为胃癌根治术术后早期复发的危险因素,而淋巴结清扫范围(OR=0.236)、术后化疗(OR=0.238)等则为保护因素。结论胃癌根治术后早期复发率较高,肿瘤越大、TNM分期越高、浆膜浸润、淋巴结转移、阳性淋巴结数越多、淋巴结清扫范围小、术后不化疗均为胃癌术后早期复发的独立危险因素。     

胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应的Meta分析

目的评价胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应。方法计算机检索2013年10月之前纳入Cochrane library图书馆、Embase数据库、Pub Med数据库、Web of Science数据库、Wanfang数据库、CNKI数据库中比较胃癌D2根治术后同期放化疗与化疗的随机对照(RCT)研究。依据数据同质性或异质性确定数据使用固定效应模型或随机效应模型。使用Rev Man 5.2软件进行数据分析,两组之间的差异用OR值和95%CI描述。结果共纳入5个RCT研究,总计979例患者。通过Meta分析得出:胃癌D2根治术后同期放化疗与化疗相比,放化疗显著提高了5年局部无复发生存率(LRRFS)及3年总生存率(OS),但不能提高5年无远处复发生存率(DMRFS)及1年、3年、5年无病生存率(DFS)和1年、5年OS;且拥有和化疗同样的1~2级、3~4级恶心呕吐不良反应及1~2级、3~4级白细胞毒性反应。结论今后研究应依据胃癌的分期、种族、淋巴结转移及淋巴结清扫数目来确定胃癌D2根治术术后同期放化疗与化疗。     

辅助化疗治疗胃癌的疗效评价和影响胃癌预后的多因素分析

目的探究对胃癌患者应用辅助化疗的临床效果,并对影响胃癌预后的因素进行分析。方法对我院2013年1月至2015年1月接收的胃癌患者60例作为研究对象,按数字奇偶法将其分为两组,对照组仅进行胃癌根治术治疗,治疗组在胃癌根治术后再应用辅助化疗进行治疗。观察两组患者治疗效果,同时对影响胃癌预后的因素进行分析。结果治疗组临床疗效为93.33%,对照组为76.67%,组间比较,治疗组明显优于对照组,具有统计学意义(P0.05);治疗组患者6个月后、1年后生存率分别为96.67%、86.67%,对照组分别为83.33%、73.33%,组间比较,统计学差异显著(P0.05);通过单因素分析结果进行多因素分析发现辅助化疗与病理类型是影响胃癌预后独立的危险因素。结论对胃癌患者在胃癌根治术后再给予辅助化疗,可提高患者生存率;辅助化疗与病理类型是胃癌患者预后的独立危险因素。     

胃癌组织中乳腺癌易感基因1表达状况与奥沙利铂方案辅助化疗疗效、预后的相关性

目的:探讨胃癌组织中乳腺癌易感基因1(breast cancer susceptibility gene 1,BRCA1)表达状况,并分析其与奥沙利铂方案辅助化疗疗效、预后的相关性.方法:选取武警四川总队医院2010-01/2011-12间110例胃癌根治术后奥沙利铂方案辅助化疗患者为研究对象,采取免疫组织化学方法测定胃癌组织中BRCA1表达,分析BRCA1表达与患者的临床疗效与预后的相关性.结果:BRCA1表达阳性vs阴性治疗有效率35.9%vs 60.6%,差异有统计学意义(P0.05);BRCA1表达阳性vs阴性患者3年无病生存(disease-free survival,DFS)率和总生存(overall survival,OS)率(30.8%vs 56.3%)、(3 8.5%vs 6 4.8%),差异有统计学意义(P0.05).结论:胃癌组织中BRCA1表达可以作为胃癌根治术后患者奥沙利铂方案辅助化疗疗效的预测指标,也可作为预后观察的重要指标.     

三棱消瘤合剂对进展期胃癌患者疾病无进展生存期及生活质量的影响

[目的]探讨三棱消瘤合剂对进展期胃癌患者疾病无进展生存期(progression-free survival,PFS)、生活质量(karnofsky,KPS)、化疗后不良反应的影响。[方法]采用前瞻性随机对照研究方法,将ⅢC/Ⅳ期胃癌患者,随机分为中药联合化疗组和单纯化疗组。PFS为主要研究终点,KPS评分、不良反应为次要研究终点,使用KaplanMeier法估算中位PFS,组间生存差异采用Log-rank进行检验,使用COX比例风险回归模型对影响PFS的预后因素进行多因素分析。使用χ2检验对KPS评分和不良反应进行统计学分析。[结果]COX多因素分析显示,中药联合化疗组治疗(P=0.011)是影响进展期胃癌患者PFS的独立预后因素。中药联合化疗组中位PFS为6.0个月,较单纯化疗组的5.0个月明显延长,生存分布差异有统计学意义(P=0.009)。2组KPS评分比较,差异有统计学意义(P0.05)。不良反应中胃肠道反应方面,化疗联合中药能减轻患者的不良反应,2组比较差异有统计学意义(P0.05)。[结论]化疗基础上联合三棱消瘤合剂能延长进展期胃癌患者的PFS,提高患者的生活质量,减轻胃肠道反应。     

加味四逆泻心汤对胃癌根治术后患者的疗效观察

目的观察中药加味四逆泻心汤预防胃癌根治术后复发转移的临床疗效。方法将52例胃癌根治术后患者随机分为处理组和对照组,处理组治疗采用加味四逆泻心汤合并FOLFOX4方案化疗,对照组采用FOLFOX4方案化疗,观察两组半年、1、2、3年累计生存率及复发转移率。结果处理组2、3年累计生存率均显著高于对照组(P0.05);处理组1、2、3年累计复发转移率均显著低于对照组(P0.05)。结论加味四逆泻心汤可以通过降低胃癌根治术后的复发转移,提高生存率。     

高龄胃癌患者手术治疗的短期疗效及预后影响因素

目的探讨高龄胃癌患者手术治疗的短期疗效及影响预后的因素。方法收集≥80岁行胃癌根治术患者的临床资料,分析手术治疗的短期疗效及预后影响因素。计数资料比较、单因素分析采用χ~2检验,多因素分析采用Cox回归分析,采用Kaplan-Meier法绘制总体生存曲线。结果单因素分析结果显示:手术时间、肿瘤直径、淋巴结阳性率、有无复发/转移病理T分期、N分期、TNM分期是影响高龄胃癌患者术后3年总体生存率的显著相关因素(P0.05)。多因素分析结果显示:N分期、复发/转移为高龄胃癌患者术后3年总体生存率的独立影响因素(P0.05)。结论高龄胃癌患者行胃癌根治术治疗的短期疗效满意,高龄胃癌患者进行手术治疗时,应重视淋巴结清扫对预后的重要意义。     

健脾扶正方对接受新辅助化疗胃癌患者近期疗效和免疫功能的影响

目的:探讨健脾扶正方应用于胃癌患者新辅助化疗的疗效。方法:将90例进展期胃癌患者按照随机数字表法分为2个组,每组45例。2组均接受新辅助化疗和胃癌根治术,中药组在新辅助化疗期间应用中药健脾扶正方,对照组仅接受新辅助化疗。比较2组近期疗效和免疫功能。结果:化疗后中药组客观有效率、疾病控制率、R0切除率均高于对照组(P<0.05),化疗后、术后第7天中药组CD3^+、CD4^+、CD4^+/CD8^+值高于对照组(P<0.05);化疗后中药组血清癌胚抗原、糖类抗原724、基质金属蛋白酶-9、血管内皮生长因子水平均低于对照组(P<0.05);中药组白细胞减少、血小板减少、贫血、恶心呕吐、食欲减退、全身乏力、脱发、口腔黏膜炎发生率低于对照组,均差异有统计学意义(P<0.05)。结论:健脾扶正方可调节细胞免疫功能,提高近期疗效,下调肿瘤标志物水平,减少不良反应发生,应用于进展期胃癌的新辅助化疗效果显著,值得临床借鉴。     

微创根治手术对进展期胃癌患者的近期和远期效果的影响

目的:探讨腹腔镜辅助胃癌根治手术对进展期胃癌患者近期及远期疗效的影响.方法:选取2007-06/2009-06首都医科大学平谷区医院普外科收治的212例行D2根治手术的进展期胃癌患者为研究对象,其中110例行常规开腹手术治疗(开腹组),102例行腹腔镜辅助胃癌根治手术治疗(腹腔镜组).比较两组患者术中、术后恢复、并发症发生率及5年总生存率(overall survival,OS)、无瘤生存(disease-free survival,DFS)、无局部区域复发生存(locoregional recurrence-free survival,LRFS)、无远处转移生存(distant metastasisfree survival,DMFS),并对术后并发症发生的危险因素进行分析.结果:腹腔镜术中出血量少于开腹组,术后进食流质时间、排气时间、住院时间短于开腹组(P0.05),两组淋巴结清扫数目、手术时间差异无统计学意义(P0.05).腹腔镜组术后并发症发生率为17.65%低于开腹组30.91%,差异有统计学意义(P0.05).经Cox风险模型风险可知,手术时间、术前合并症、是否行腹腔镜手术是胃癌根治术后并发症发生的独立危险因素.术前合并症及手术时间是腹腔镜辅助胃癌根治手术的独立危险因素.腹腔镜组5年OS、DFS、LRFS、DMFS与开腹手术相比差异无统计学意义(P0.05).结论:腹腔镜治疗进展期胃癌可获得与开腹手术相同的治疗效果,且具有显著的微创优势.术前合并症及手术时间是影响腹腔镜治疗进展期胃癌术后并发症的独立危险因素.     

多西他赛联合奥沙利铂及替吉奥对比奥沙利铂联合替吉奥在ⅢC期胃癌术后辅助化疗的临床疗效及不良反应分析

目的比较多西他赛联合奥沙利铂、替吉奥方案与奥沙利铂联合替吉奥方案在ⅢC期胃癌术后辅助化疗的临床疗效及不良反应。方法回顾性分析33例术后分期为ⅢC期的胃癌患者,其中13例术后辅助化疗采用了多西他赛联合奥沙利铂、替吉奥治疗(三药组),20例采用了奥沙利铂联合替吉奥治疗(两药组)。收集两组患者相关资料进行统计分析,比较三药组及两药组的无疾病生存时间(DFS)、总生存时间(OS)及不良反应。结果三药组和两药组的中位DFS分别为22个月和18个月,差异有统计学意义(P=0.018),中位OS分别为27个月和22个月,差异无统计学意义(P=0.066)。两组患者不良反应主要包括骨髓抑制、恶心、呕吐、周围神经毒性及肝肾功能异常等。其中,三药组Ⅲ~Ⅳ度白细胞减少(46.2%vs 10.0%)及血小板降低(30.8%vs 5.0%)的发生率高于两药组,差异有统计学意义(P=0.034,P=0.046);三药组恶心、呕吐发生率也略高于两药组(38.5%vs 20.0%),但差异无统计学意义(P=0.319);其他不良反应包括肝肾功能异常、周围神经毒性等,两组比较,差异均无统计学意义(P>0.05)。结论对于术后分期为ⅢC期的胃癌患者,在奥沙利铂联合替吉奥的标准治疗基础上,加入多西他赛的三药方案,可延长患者的DFS,降低复发转移的风险,且不良反应可耐受,值得扩大样本进一步临床研究。     

老年胃癌根治术病人术后肺部感染的影响因素分析

目的探讨老年胃癌根治术病人的临床病理特征及术后肺部感染的影响因素。方法回顾性分析2016年1月至2019年6月我院收治的120例行根治性手术治疗的老年胃癌病人的临床资料,根据病人术后是否发生肺部感染将其分为研究组(n=26)和对照组(n=94)。比较2组病人的临床病理资料,并采用多因素Logistic回归分析老年胃癌根治术病人并发术后肺部感染的独立危险因素。结果年龄(OR=3.570,95%CI1.150~9.875)、低白蛋白血症(OR=3.003,95%CI2.851~4.623)、胃肠减压(OR=7.538,95%CI3.101~18.203)、围术期输血(OR=6.813,95%CI5.323~8.303)、伤口疼痛(OR=3.417,95%CI1.546~7.537)、吸烟史(OR=3.662,95%CI1.680~7.992)是老年胃癌根治术病人并发术后肺部感染的独立危险因素。结论老年胃癌根治术病人并发术后肺部感染的独立危险因素主要为高龄、低白蛋白血症、胃肠减压、围术期输血、伤口疼痛、吸烟史,建议针对上述因素加强干预措施。     

进展期胃癌术后调强放疗加同期口服替吉奥胶囊化疗的临床疗效

目的:评价调强放疗加替吉奥胶囊配合中药调理胃肠道方案治疗进展期胃癌术后的临床疗效与不良反应.方法:68例进展期胃癌患者按先后入院顺序半随机分成观察组35例,术后4wk开始行靶区调强放射治疗(每日180Cgy,每周5次,总剂量45-55GY),对照组33例行常规放疗.两组均加口服替吉奥胶囊80mg/(m2·d),分2次口服,连服14d、21d为1周期,连用2个周期,放化疗期间给予中药调理胃肠道.治疗后进行两组临床疗效不良反应比较,治疗后3mo分析疗效和不良反应,治疗前、治疗后3mo、6mo、12mo随访进行Karnofsky生活质量评分.结果:两组临床疗效比较,观察组总有效率为51.43%,对照组为30.30%,两组临床疗效无统计学差异(P>0.05).Karnofsky评分结果表明,观察组与对照组分别治疗前与治疗后3mo、6mo、12mo比,有统计学差异(P<0.01,P<0.05),治疗后3mo、6mo、12mo观察组与对照组比,有统计学意义(P<0.02,P<0.05).两组血液学不良反应、胃肠道反应、周围神经不良反应比较,观察组比对照组小.结论:经过临床对照研究分析结果表明,进展期胃癌患者术后行调强放疗...     

The Efficacy of Taxanes- and Oxaliplatin-Based Chemotherapy in the Treatment of Gastric Cancer After D2 Gastrectomy for Different Lauren Types

To investigate the efficacy of Taxanes- and Oxaliplatin-based chemotherapies (TC and OC) in the treatment of gastric cancer patients after D2 gastrectomy with different Lauren types. In this study, 299 patients of gastric adenocarcinoma with D2 lymph node dissection were reviewed between 2007 and 2014. Chemotherapies were classified as Oxaliplatin-based and Taxanes-based regimen. Treatment outcomes were analyzed according to different Lauren types, such as the intestinal type, diffuse type, and mixed type groups, respectively. The disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan–Meier method. The log-rank test was used for univariate analysis, and Cox regression was used for multivariate analysis. In diffuse type gastric cancer, the Oxaliplatin-based arm had a longer median DFS and OS compared with Taxanes-based arm (DFS: 47.0 vs 28.6 months, P = 0.04; OS: 51.9 vs 34.5 months, P = 0.048). The chemotherapy regimen was an independent prognostic factor for DFS and OS of diffuse type gastric cancer patients by multivariate analysis (P = 0.01). In the intestinal type, although the DFS and OS of intestinal type patients in TC group were higher than those in OC group (DFS: 53.4 vs 42.4 months; OS: 69.7 vs 57.8 months), there was no statistical significance observed (both P > 0.05). For the mixed type, the 2 different chemotherapy regimens achieved similar median DFS and OS. In a conclusion, the patients of diffuse type were more sensitive to OC, and the intestinal type patients may be benefit from TC. Therefore, it will be of benefit for gastric patients by introducing Lauren classification clinically and to help the choice of chemotherapy regimen for gastric patients after D2 gastrectomy.     

Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas

AIM: To study the efficacy of the enhanced recovery after surgery(ERAS) program in laparoscopic radical gastrectomy for stomach carcinomas.METHODS: From June 2010 to December 2012, 61 gastric cancer patients who underwent laparoscopicassisted radical gastrectomy with D2 lymphadenectomy at First Hospital of Jilin University were enrolled in this randomized controlled trial.(Clinical Trials.gov, registration ID: NCT01955096). The subjects were divided into the ERAS program group and the conventional control group. The clinical characteristics, recovery variables, and complications of patients were analyzed.RESULTS: The time to first ambulation, oral food intake, and time to defecation were significantly shorter in the ERAS group(n = 30), compared to the conventional group(n = 31; P = 0.04, 0.003, and 0.01, respectively). The postoperative hospital stay was less in the ERAS group(6.8 ± 1.1 d) compared to the conventional group(7.7 ± 1.1 d)(P = 0.002). There was no significant difference in postoperative complications between the ERAS(1/30) and conventional care groups(2/31)(P = 1.00). There were no readmissions or mortality during the 30-d follow-up period.CONCLUSION: The ERAS program is associated with a shorter hospital stay in gastric cancer patients undergoing laparoscopic radical gastrectomy. The ERAS protocol is useful in the treatment of gastric cancer.     

Upper abdominal stop-flow perfusion as a neo and adjuvant hypoxic regional chemotherapy for resectable gastric carcinoma. A prospective randomized clinical trial.

BACKGROUND/AIMS: Gastric cancer remains a disease with a poor and dismal prognosis even after radical surgical resection. The present study attempts to clarify whether neo and adjuvant hypoxic upper abdominal chemotherapy can improve the survival of patients with gastric cancer undergoing radical surgical resection. Patterns of failure after surgery for gastric cancer include peritoneal seeding, resection margin recurrence, and liver metastasis. METHODOLOGY: From October 1995 to February 1999, 58 patients with resectable gastric cancer were randomly assigned to three groups. Hypoxic upper abdominal chemotherapy was carried out using Mitomycin-C, 5-Fluorouracil, Leucovorin, and Farmorubicin, 10 days before surgery, and 20 days following surgery, in Group A (n=20) with or without in Group B (n=19) systemic chemotherapy; the remaining patients (Group C: n=19) had neither neo nor adjuvant treatment. RESULTS: The 4-year survival of Group C patients was 29.2%. Group A patients (surgery plus hypoxic neo and adjuvant chemotherapy and systemic chemotherapy) had a 4-year survival of 45.5% versus a 4-year survival of 39.2% of Group B patients (surgery and hypoxic neo and adjuvant abdominal perfusion). Patients of all stages, histologically confirmed, were included in this study. CONCLUSIONS: Patients suffering from gastric carcinoma have demonstrated statistically improved survival by combining resectional surgery with neo and adjuvant hypoxic upper abdominal perfusion and adjuvant systemic chemotherapy.     

品管圈活动在新生儿科医院感染控制中的应用成效

[目的]探讨品管圈活动在新生儿科医院感染控制中的应用成效。[方法]选择260例新生儿和全体医护人员作为对照组(品管圈活动实施前),另260例新生儿和全体医护人员作为研究组(品管圈活动后),比较两组医院感染发生率、医护人员手卫生依从性。[结果]研究组医院感染发生率为1.92%,明显低于对照组的5.38%(P<0.05)。研究组医护人员手卫生依从性为91.18%,显著高于对照组的70.59%(P<0.05)。[结论]在新生儿科护理工作中开展品管圈活动,有效降低医院感染发生率,提高医护人员手卫生依从性。     

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.     

Survival of gastric cancer with concomitant liver metastases

BACKGROUND/AIMS: Prognosis of gastric cancer with concomitant liver metastasis is poor. Gastrectomy and chemotherapy had been reported to be beneficial to this group of patients. Whether all the patients can benefit from that treatment modality and whether the clinical characteristics can give some information about survival have not been evaluated. METHODOLOGY: Eighty-three gastric cancer patients with concomitant liver metastases who had received treatment in the past 10 years were retrospectively studied with special reference to different extent of liver metastases. Clinical characteristics (peritoneal tumor dissemination, tumor markers, clinicopathological factors), treatment modalities (gastrectomy or chemotherapy) and survival were analyzed for their possible relationship with the extent of liver metastases. RESULTS: There were 33 patients with liver metastases limited to one lobe and 50 patients had metastases in both lobes. The clinicopathological characteristics show no difference between uni- and bilobar liver metastases except higher percentage of concomitant peritoneal dissemination in patients with bilobar disease. More unilobar involvement patients underwent gastrectomy (70% vs. 48%, p=0.018). Higher frequency of abnormal CEA level in bilobar metastases (38% vs. 60%, p=0.045). Median survival of unilobar metastasis is 7.8 months and 4.3 months for the bilobar involvement (p=0.001). Gastrectomy might prolong the survival in patients with unilobar metastasis (p=0.005), but not in patients with bilobar diseases (p=0.074). Chemotherapy could prolong the survival in patients without gastrectomy, but not the survival after gastrectomy. CONCLUSIONS: The clinicopathological characteristics and tumor markers have no role in predicting the survival among patients with liver metastases. Both gastrectomy and chemotherapy for the patients without gastrectomy could prolong survival, but chemotherapy could not prolong the survival after gastrectomy, the benefit of resection and chemotherapy are probably caused by selection bias.