胃癌介入治疗的疗效评价探讨

Is Muller's criteria practicable for tumor response to gastric arterial chemoembolization?

目的 评价胃癌介入治疗疗效评价更为可靠的标准。方法 分析病理证实的１０４ 例无手术指征的胃癌患者（ 含术后复发） 、影像诊断胃癌同时检出其他部位转移而无病理诊断者４３ 例，行胃动脉内化疗栓塞、转移灶化疗栓塞。术后用ＣＴ、ＧＩ和胃镜随访病灶。采用ＣＯＸ 肿瘤生存模型进行生存随访。结果 １ ． 胃癌原发灶治疗后，明显的缩小占６０．８ ％ ，２３．２ ％ 无明显反应，１７％ 在治疗中途出现病灶增大或转移至其他部位；ＣＴ随访碘化油沉积越浓，占肿瘤体积比例越大，滞留时间越长，肿瘤缩小越明显。淋巴结和转移灶在动脉内化疗栓塞后均有程度不等的缩小。２ ．１４７ 例患者中，至今存活５７ 例。首次治疗距统计日已满１２ 月者８５ 例，大于１２ 月者７９ 例，占５３ ．７％ （７９／１４７）；距统计日２４ 月者９４ 例，生存期等于或大于３６ 月者１９ 例，占１２．９ ％ ；距统计日５ 年以上者３１ 例，存活５ 年以上者９ 例，占６１．２％ 。结论 胃癌病灶介入治疗评价应包括原发灶、转移灶和淋巴结的改变，单纯以大小改变不能准确反映治疗疗效，更为主要的是肿瘤内部结构的变化。同时作者提出非肿块病灶缩小率的评价标准。

Objective Till now, Muller's Criteria has been undertaken widely for evaluating tumor response, but it has pitfalls for gastric tumors. On the purpose of getting more practicable criteria for gastric carcinoma, the patients were analyzed serieslly with treatment by gastric arterial chemoembolization. Methods A hundred and forty seven patients included 106 males and 41 females, with an average age of 59. A hundred and four patients had tumor confirmed histologically. Forty three patients were diagnosed by imaging with primary focus in the stomach, and metastatic focus in other organs. All patients had no indication for ra dical resection when the diagnoses were obtained. They received combined infusion chemotherapy and chemoembolization with lipiodol mixture. CT scan, GI and gastroscopy were performed for postoperative follow up on lymph nodes, primary and metastatic tumor. COX survival model was undertaken for analyzing patients survival. Results The obvious reduction of tumor size (CR+PR) occurred in sixty patients (60.8%), and twenty three patients had no response (23.2%). During treatment 17% patients revealed tumor enlargement or metastases. 76 patients with GAE management had obviously reduced half of the size more than 50% Lp CT scan demonstrated that the size and time of Lipiodol status were positive in proportion with response of tumor. Lymph node and metastases. 57 patients were alive, the survival rate of 1,3,5 year were 53.7%(79/147), 12.9%(19/147), and 6.12%(9/147) respectively. Conclusions For accessing response of gastric tumor should include focus, metastases and lymph node. Tumor response can't be accessed only by tumor size, the structive change of tumor also ought to be taken care of even more important.