133例胃癌肝转移患者的预后分析

 目的  探讨影响胃癌肝转移患者预后的相关因素。方法  回顾性分析2009年5月至2014年3月复旦大学附属中山医院收治的133例胃癌肝转移患者的临床病理资料。Kaplan-Meier法行单因素生存分析,COX比例风险模型对影响预后的因素进行多因素分析。结果  133例胃癌肝转移患者总体中位生存期9.9个月(95%CI:8.1~11.7个月),1年、2年、3年生存率分别为51.6%、21.0%及11.2%。单因素分析显示,原发肿瘤分化程度、肝转移癌程度、确诊肝转移时的白蛋白水平均与预后相关,而性别、年龄、发生肝转移时间、原发肿瘤部位、是否合并肝外转移、确诊肝转移时的血红蛋白、肿瘤标志物、Her-2状态均与预后无关。多因素分析显示,原发肿瘤分化程度、肝转移癌程度是影响胃癌肝转移预后的独立因素。在治疗上,133例患者中,24例患者采取了最佳支持治疗(best supportive care,BSC),109例患者接受了姑息化疗。接受BSC的患者生存期明显短于接受姑息化疗的患者(12.0个月vs. 2.8个月,P=0.000)。接受多线化疗的患者的生存期明显长于仅接受单线姑息化疗的患者(14.7个月 vs. 8.0个月,P=0.000)。在姑息化疗的基础上加用局部治疗未取得更长的总生存时间。结论  姑息化疗能显著延长胃癌肝转移患者的总生存时间,针对胃癌肝转移患者应尽量让其获得多线化疗的机会。

Prognostic analysis of 133 gastric cancer patients with liver metastases

Objective  To investigate the prognostic factors of the patients with hepatic metastases from gastric cancer.Methods  The clinico-pathological data of 133 patients with livermetastases from gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from May 2009 to March 2014 were retrospectively analyzed.Kaplan-Meier analysis was used to estimate the overall survival (OS).Cox proportional-hazards regression model was employed to analyze the prognostic factors.Results  The median overall survival (MST) of the 133 patients was 9.9 months (95%CI:8.1-11.7 mo).The OS 1-,2-and 3-year rates were 51.6%,21.0% and 11.2%,respectively.Univariate analysis showed that the differentiation of primary tumor,the extent of liver metastases and the albumin concentration were related to overall survival,while the age,gender,gastric cancerlocation,tumor markers,hemoglobin,timing of liver metastases,extrahepatic metastases,Her-2 status were not associated to OS.Multivariate analysis revealed that the differentiation of primary cancer,the extent of liver metastases were independent prognostic factors.As for treatment,24 patients adopted best supportive care (BSC) and 109 patients accepted systemic chemotherapy.The survival of BSC was significantly poor than systemic chemotherapy (12.0 mo vs. 2.8 mo,P=0.000).Patients with multi line chemotherapy had a significant longer survival than with single linechemotherapy (14.7 mo vs 8.0 mo,P=0.000).Local therapy combined with systemic chemotherapy didn′t prolong the survival.Conclusions  Systemic chemotherapy could significantly prolong the survival of gastric cancer patients with liver metastases,and salvage chemotherapy should be recommended to this group of patients as possible.