晚期胃癌姑息放疗的疗效观察及预后分析

摘要/Abstract

摘要：

目的探讨姑息放疗在晚期胃癌患者中的临床疗效及预后影响因素。方法收集2013年1月至2018年12月于华中科技大学同济医学院附属协和医院肿瘤中心诊治的390例晚期胃癌患者的临床资料,根据治疗方法分为联合放化疗组(n=95)和单纯化疗组(n=295)。采用门诊复查、电话及短信等方式进行定期随访。回顾性分析姑息放疗在晚期胃癌患者中的临床疗效及预后影响因素。结果联合放化疗组中位生存时间28.07个月、6个月生存率89.0%、1年生存率68.0%、2年生存率51.0%,单纯化疗组中位生存时间11.27个月、6个月生存率69.0%、1年生存率40.0%、2年生存率15.0%,联合放化疗组生存率优于单纯化疗组(χ²=27.400,P<0.001)。289例初诊晚期胃癌患者中,联合放化疗组中位生存时间28.07个月,显著长于单纯化疗组的11.47个月(χ²=23.681,P<0.001)。101例术后复发胃癌患者中,联合放化疗组中位生存时间16.37个月,显著长于单纯化疗组的10.53个月(χ²=5.164,P=0.023)。放疗前化疗方案(χ²=7.019,P=0.030)、放疗前疾病控制情况(χ²=4.689,P=0.030)、放疗前美国东部肿瘤协作组(ECOG)评分(χ²=8.529,P=0.014)、放疗部位(χ²=4.763,P=0.029)是影响行姑息放疗晚期胃癌患者预后的相关因素。多因素分析显示,放疗前ECOG评分(HR=2.252,95%CI为1.288~3.935,P=0.004)、放疗前疾病控制情况(HR=2.604,95%CI为1.183~5.730,P=0.017)是影响患者生存的独立预后因素。结论对于初诊晚期胃癌患者及术后复发胃癌患者,联合放化疗疗效显著优于单纯化疗。放疗前化疗方案、放疗前疾病控制情况、放疗前ECOG评分、放疗部位对行姑息放疗晚期胃癌患者的预后产生影响,其中放疗前ECOG评分、放疗前疾病控制情况是影响患者生存的独立预后因素。

关键词:胃肿瘤,放射疗法,姑息疗法,预后

Abstract:

ObjectiveTo investigate the efficacy and prognostic factors of palliative radiotherapy for advanced gastric cancer.MethodsFrom January 2013 to December 2018, the clinical data of 390 patients with advanced gastric cancer in the Cancer Center of Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected. Patients were divided into two groups—combined chemoradiotherapy group (n=95) and chemotherapy alone group (n=295) according to the treatment method. Patients were followed up by outpatient reviews, phone calls or text messages at regular intervals. The clinical efficacy and prognostic factors of palliative radiotherapy in patients with advanced gastric cancer were retrospectively analyzed.ResultsThe median survival time and the 6-month, 1-year, 2-year survival rates of combined chemoradiotherapy group and chemotherapy alone group were respectively 28.07 monthsversus11.27 months, 89.0%versus69.0%, 68.0%versus40.0%, 51.0%versus15.0%. The survival rate of the combined chemoradiotherapy group was significantly higher than that of the chemotherapy alone group (χ²=27.400,P<0.001). The median survival time of the combined chemoradiotherapy group was significantly longer than that of chemotherapy alone group in both 289 first-time diagnosed patients (χ²=23.681,P<0.001) and 101 recurrent gastric cancer patients (χ²=5.164,P=0.023), with median survival time being 28.07 monthsversus11.47 months and 16.37 monthsversus10.53 months respectively. Chemotherapy regimen before radiotherapy (χ²=7.019,P=0.030), disease control before radiotherapy (χ²=4.689,P=0.030), Eastern Cooperative Oncology Group (ECOG) score before radiotherapy (χ²=8.529,P=0.014) and radiotherapy area (χ²=4.763,P=0.029) were factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. Multivariate analysis showed that ECOG score (HR=2.252, 95%CI: 1.288-3.935,P=0.004) and disease control before radiotherapy (HR=2.604, 95%CI: 1.183-5.730,P=0.017) were independent prognostic factors.ConclusionThe efficacy of combined chemoradio-therapy is significantly better than chemotherapy alone in both first-time diagnosed and recurrent advanced gastric cancer. Chemotherapy regimen before radiotherapy, disease control before radiotherapy, ECOG score before radiotherapy and radiotherapy area are factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. ECOG score and disease control before radiotherapy are independent prognostic factors.

Key words:Stomach neoplasms,Radiotherapy,Palliative care,Prognosis

朱莹, 周丹阳, 于丹丹, 张涛. 晚期胃癌姑息放疗的疗效观察及预后分析[J]. 国际肿瘤学杂志, 2020, 47(3): 151-156.

Zhu Ying, Zhou Danyang, Yu Dandan, Zhang Tao. Efficacy and prognosis of palliative radiotherapy for advanced gastric cancer[J]. Journal of International Oncology, 2020, 47(3): 151-156.

图/表7

表1

两组晚期胃癌患者一般临床特征[例(%)]"

临床特征	联合放化疗组 (n=95)	单纯化疗组 (n=295)	χ²值	P值
性别
男	49(51.6)	176(59.7)	1.923	0.166
女	46(48.4)	119(40.3)
年龄(岁)
≥53	52(54.7)	128(43.4)	3.723	0.054
<53	43(45.3)	167(56.6)
肿瘤原发部位
贲门	26(27.4)	82(27.8)
胃体	29(30.5)	59(20.0)	7.288	0.063
胃窦	34(35.8)	112(38.0)
全胃及残胃	6(6.3)	42(14.2)
分化程度
分化良好型	19(20.0)	36(12.2)
分化不良型	53(55.8)	177(60.0)	3.657	0.161
不详	23(24.2)	82(27.8)
初诊分期
Ⅳ期	67(70.5)	222(75.3)	0.837	0.360
非Ⅳ期	28(29.5)	73(24.7)

表1

图1

图2

图3

图4

表2

95例晚期胃癌行姑息放疗患者单因素预后分析"

临床特征	例数(%)	中位生存时间(月)	χ²值	P值
性别
男	49(51.6)	34.10	0.429	0.513
女	46(48.4)	23.50
年龄(岁)
≥53	52(54.7)	34.10	1.535	0.215
<53	43(45.3)	28.07
肿瘤原发部位
贲门	26(27.4)	34.10
胃体	29(30.5)	23.50	1.139	0.768
胃窦	34(35.8)	28.07
全胃及残胃	6(6.3)	36.70
转移部位
单纯淋巴结及单一器官	50(52.6)	36.70	0.899	0.343
腹腔及多部位	45(47.4)	20.67
分化程度
分化良好型	19(20.0)	34.10
分化不良型	53(55.8)	23.50	1.112	0.573
不详	23(24.2)	19.23
初诊分期
Ⅳ期	67(70.5)	28.07	0.043	0.836
非Ⅳ期	28(29.5)	16.37
放疗前ECOG评分
0	28(29.5)	-
1	59(62.1)	20.67	8.529	0.014
2	8(8.4)	11.53
放疗前化疗方案
方案不详	13(13.7)	11.53
氟尿嘧啶类联合或不联合铂类方案^a	60(63.2)	36.70	7.019	0.030
紫杉类或伊立替康方案	22(23.1)	14.43
放疗前疾病控制情况
PR/SD	67(70.5)	28.07	4.689	0.030
PD	28(29.5)	11.53
同步化疗情况
是	31(32.6)	-	3.720	0.054
否	64(67.4)	20.67
放疗部位
原发灶	48(50.5)	-	4.763	0.029
转移灶	47(49.5)	19.23

表2

变量	β值	SE值	Wald值	HR值	95%CI	P值
放疗前ECOG评分	0.812	0.285	8.117	2.252	1.288~3.935	0.004
放疗前疾病控制情况	0.957	0.402	5.656	2.604	1.183~5.730	0.017
放疗前化疗方案	0.186	0.150	1.541	1.204	0.898~1.615	0.214
放疗部位	0.359	0.383	0.878	1.432	0.676~3.035	0.349

表3

参考文献13

[1]	Bray F, Ferlay J, Soerjomataram I , et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018,68(6):394-424. DOI: 10.3322/caac.21492. doi:10.3322/caac.v68.6
[2]	孙可欣, 郑荣寿, 张思维 , 等. 2015年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2019,28(1):1-11. DOI: 10.11735/j.issn.1004-0242.2019.01.A001.
[3]	Katai H, Ishikawa T, Akazawa K , et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001-2007)[J]. Gastric Cancer, 2018,21(1):144-154. DOI: 10.1007/s10120-017-0716-7. doi:10.1007/s10120-017-0716-7
[4]	Gomez Martin C, Plaza JC, Pazo Cid R , et al. Level of HER2 gene amplification predicts response and overall survival in HER2-positive advanced gastric cancer treated with trastuzumab[J]. J Clin Oncol, 2013,31(35):4445-4452. DOI: 10.1200/JCO.2013.48.9070. doi:10.1200/JCO.2013.48.9070
[5]	Smalley SR, Benedetti JK, Haller DG , et al. Updated analysis of SWOG-directed intergroup study 0116: a phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection[J]. J Clin Oncol, 2012,30(19):2327-2333. DOI: 10.1200/JCO.2011.36.7136. doi:10.1200/JCO.2011.36.7136
[6]	Muro K, Van Cutsem E, Narita Y , et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with metastatic gastric cancer: a JSMO-ESMO initiative endorsed by CSCO, KSMO, MOS, SSO and TOS[J]. Ann Oncol, 2019,30(1):19-33. DOI: 10.1093/annonc/mdy502. doi:10.1093/annonc/mdy502
[7]	Eisenhauer EA, Therasse P, Bogaerts J , et al. New response evaluation criteria in solid tumours: revised RECIST guideline(version 1.1)[J]. Eur J Cancer, 2009,45(2):228-247. DOI: 10.1016/j.ejca.2008.10.026. doi:10.1016/j.ejca.2008.10.026
[8]	Trotti A, Colevas AD, Setser A , et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment[J]. Semin Radiat Oncol, 2003,13(3):176-181. DOI: 10.1016/S1053-4296(03)00031-6. doi:10.1016/S1053-4296(03)00031-6
[9]	Lordick F, Kang YK, Chung HC , et al. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer(EXPAND): a randomised, open-label phase 3 trial[J]. Lancet Oncol, 2013,14(6):490-499. DOI: 10.1016/S1470-2045(13)70102-5. doi:10.1016/S1470-2045(13)70102-5
[10]	Bang YJ, Xu RH, Chin K , et al. Olaparib in combination with paclitaxel in patients with advanced gastric cancer who have progressed following first-line therapy(GOLD): a double-blind, randomised, placebo-controlled, phase 3 trial[J]. Lancet Oncol, 2017,18(12):1637-1651. DOI: 10.1016/S1470-2045(17)30682-4. doi:10.1016/S1470-2045(17)30682-4
[11]	刘畅, 贾茹, 鲁智豪 , 等. 145例晚期胃癌姑息性放疗患者的临床病理特征及预后分析[J]. 肿瘤综合治疗电子杂志, 2018,4(1):57-61.
[12]	Dong HM, Wang Q, Wang WL , et al. A clinical analysis of systemic chemotherapy combined with radiotherapy for advanced gastric cancer[J]. Medicine (Baltimore), 2018,97(23):e10786. DOI: 10.1097/MD.0000000000010786. doi:10.1097/MD.0000000000010786
[13]	Tey J, Soon YY, Koh WY , et al. Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis[J]. Oncotarget, 2017,8(15):25797-25805. DOI: 10.18632/Oncotarget.15554. doi:10.18632/oncotarget.v8i15

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