636例胃癌患者临床治疗现状分析

Clinical analysis of the current treatment status of gastric cancer in 636 patients

目的探讨胃癌的临床治疗现状。方法回顾性分析636例胃癌患者的临床资料，对胃癌的临床病理因素以及临床治疗情况进行分析。结果636例胃癌患者中，Ⅲ期234例，Ⅳ期290例；远端胃癌295例，近端胃癌263例，印戒细胞癌44例，腺癌546例。284例接受根治性手术，其中省级及以上医院的患者病理检测淋巴结数Et≥10枚的比例（57．9％）较地市级及以_F医院明显提高（39．6％，P=0．009）；省级及以上医院的患者中位无病生存期（DFS）和中位总生存期（OS）分别为21．7和52．9个月，较地市级及以下医院患者明显延长（14．6和33．8个月，P值分别为0．005和0．040）。接受辅助化疗205例，省级及以上医院辅助化疗≥6个周期患者所占比例（42．1％）与地市级及以下医院（35．2％）比较，差异无统计学意义（19=0．318）；在省级及以上医院行辅助化疗的患者DFS为22：7个月，较在地市级及以下医院行辅助化疗的患者明显延长（16．3个月，P=O．005）。Ⅳ期或术后复发转移患者接受解救性化疗387例，中位0s为11．1个月。其中，接受二线及以上化疗的患者中位os为12．5个月，明显长于未接受二线及以上化疗者（7．7个月，P〈0．001）。化疗联合曲妥珠单抗一线治疗患者的无进展生存期（PFS）明显延长（P〈0．05），0s较顺铂＋氟尿嘧啶类、紫杉烷＋铂类、紫杉醇＋铂类＋氟尿嘧啶类方案均明显延长（P〈0．05），其余各方案问的PFS和OS比较，差异均无统计学意义（均P〉0．05）。结论不同级别医院的医师对胃癌规范化治疗的理念不同，导致疗效差异较大。

Objective To evaluate the current clinical treatment status of gastric cancer in China. Methods A retrospective analysis of clinicopathological characteristics of 636 patients with gastric cancer was conducted. Tumor response was evaluated using RECIST version 1.1 criteria. Results Six hundred and thirty-six patients were included in this retrospective cohort： 479 men and 157 women. The median age was 57 years （14 to 86）. The tumor site was： proximal （41.4%）, distal （46.4%） or unknown （12.2%）. The histology was： adenocarcinoma （85.8%）, signet ring cell carcinoma （6.9%）, or other and unknown （7.2%）. The differentiation of the adenoearcinomas was： well differentiated （31.0%）, moderately differentiated （ 13.4% ）, poorly differentiated （37.0%）, or unknown （ 18.7% ）. The pTNM stage was ： 0 （0.3%）, Ⅰ （3.6%）, II （10.1%）, Ⅲ （36.8%）, IV （45.6%）, or unknown （3.6%）. In 284 patients who underwent radical resection, the ratio of examined ten and/or more lymph nodes was higher in hospitals at or above provincial level than in hospitals at regional level （57.9% vs. 39.6% , P = 0.009）. The disease-free survival was longer （21.7 m vs. 14.6 m, P =0. 005） , and the overall survival was longer too （52.9 m vs. 33.8 m, P = 0. 040）. In 205 patients who received adjuvant chemotherapy, the ratio of administered six and/or more cycles chemotherapy was 42.1% vs. 35.2% （P = 0. 318） , and the disease-free survival was 22.7 m vs. 16.3 m （ P = 0. 005 ） between hospitals at or above provincial level and hospitals at regional level. In 387 patients with metastatic or unresectable gastric cancer who received palliative chemotherapy, the overall survival was ll. 1 m （95% CI 9.9-12.3 m）. Among them, 198 patients received second and/or more line chemotherapy, and the overall survival was longer （ 12.5 m vs. 7.7 m, P 〈 0. 001 ）. Except a longer progression-free survival （ 10.2 m, P 〈 0.05 ） and a longer overall survival （ 16.9 m, P 〈 0.05 ）were corresponded with the regimen containing trastuzumab, no other significant difference was observed among regimens in first line chemotherapy. Conclusion Chinese doctors working in different level hospitals have a different understanding of the treatment standard of gastric cancer, which resulted in different outcomes.