影响晚期胃癌患者疗效和预后的相关因素分析

Relative factor analysis for prognosis and efficacy in patients with advanced gastric cancer

目的分析影响晚期胃癌患者疗效和预后的相关因素。方法回顾性分析临床病理特征、接受不同化疗方案的治疗情况及HER-2基因表达等因素对晚期胃癌患者疗效和预后的影响。结果 2008年12月至2011年8月共纳入192例晚期胃癌患者,182例接受联合方案一线治疗,其中156例可评价疗效,有效率(RR)为19.9%,三药方案的有效率优于两药方案(27.0%vs.15.1%,P=0.008),三药方案中含靶向药物优于不含靶向药物(33.3%vs.14.3%,P=0.012);108例接受二线治疗,其中69例可评价疗效,RR为13.0%,单药方案与多药方案的有效率、中位疾病进展时间差异均无统计学意义。接受二线治疗者较仅行一线治疗者的中位生存时间明显延长(14.1个月vs.7.3个月,P<0.001)。HER-2阳性患者接受含曲妥珠单抗方案治疗的有效率显著高于单纯化疗方案,其中一线治疗的RR分别为45.4%和11.0%(P=0.008),二线治疗的RR分别为50.0%和10.0%(P=0.009)。Cox多因素回归分析显示,ECOG评分、HER-2表达、肿瘤负荷以及是否接受二线治疗是晚期胃癌患者的预后独立因素。Logistic多元回归分析提示靶向治疗对疗效有显著影响。结论一线治疗应用含靶向药物的三药联合方案可显著提高晚期胃癌的疗效,二线治疗使晚期胃癌的预后明显改善。HER-2表达情况将影响治疗的选择,从而影响患者的预后。

Objective To analyze the prognosis and efficacy related factors in patients with advanced gastric cancer.Methods The efficacy and prognosis related factors of patients with advanced gastric cancer including clinical and pathological features,HER-2 gene expression,first-line and second-line regimen were analyzed.Results There were 192 patients with advanced gastric cancer enrolled from December 2008 to August 2011.One hundred and fifty-six patients receiving the first-line treatment of combined therapy were available for evaluation,and the response rate（RR） was 19.9%,and the RR of triple drug regimen was better than that of double drug regimen（27.0% vs.15.1%,P=0.008）.The RR of regimen containing targeted agent was much better than chemotherapy alone regimen（33.3% vs.14.3%,P=0.012）.There were 108 cases receiving the second-line treatment,and the RR of 69 evaluatable patients was 13.0%.There were no significant difference in both RR and median time to progression（TTP） between the single-drug regimen and multi-drug regimen.Patients accepting the second-line treatment had significantly longer median overall survival（OS） compared with the first-line treatment（14.1 months vs.7.3 months,P0.001）.HER-2 positive patients who received regimen containing trastuzumab obtained higher RR than chemotherapy alone regimen in the first-line treatment（45.4% and 11.0%,P=0.008）.In the second-line treatment,the RR was 50.0% and 10.0%（P=0.009）,respectively.COX regression analysis showed that performance status,HER-2 expression,tumor burden and the second-line treatment were independent prognostic factors in patients with advanced gastric cancer.Logistic multiple regression analysis indicated that targeted therapy had significant impact on RR.Conclusion The triple drug regimen containing targeted drug can significantly improve the efficacy of advanced gastric cancer in the first-line treatment.Application of the second-line treatment will improve the prognosis significantly.HER-2 expression will influence the treatment option,and lead to significant difference in patient＇s prognosis.