111例胃癌和胃食管结合部癌合并恶性胸腹腔积液患者的预后分析

Analysis of the prognosis of 111 patients with gastric cancer or adenocarcinoma of the esophagogastric junction combined with pleural or abdominal effusion

目的分析胃癌和胃食管结合部癌合并恶性胸腹腔积液患者的预后，并探讨其影响因素。方法回顾性分析2001年1月至2010年12月中国医学科学院肿瘤医院收治的111例胃癌和胃食管结合部癌合并恶性胸腹腔积液患者的临床病理资料，比较不同临床病理特征患者的积液控制情况和预后。结果111例患者中，治疗后积液消失12例（10．8％），减少36例（32．4％），稳定15例（13．5％），增多48例（43．2％），积液控制率为56．8％。女性、单纯腹腔积液、KPS评分≥80分、初诊合并积液、无肝转移和全身化疗有效的患者积液控制情况较好。111例患者的中位生存时间为6．0个月。单因素分析的结果显示，女性、KPS评分≥80分、初诊时合并积液、单纯腹腔积液、少量积液、无肝转移、接受全身化疗、积液控制、全身化疗有效、血红蛋白和白蛋水平正常、总胆红素、直接胆红素和间接胆红素水平正常的患者预后较好（均P〈0．05）。多因素分析的结果显示，有无肝转移和积液控制情况是影响胃癌和胃食管结合部癌合并恶性积液患者预后的独立因素（均P〈0．05）。结论女性、单纯腹腔积液、KPS评分≥80分、初诊合并积液、无肝转移和全身化疗有效的胃癌和胃食管结合部癌合并恶性积液患者积液控制情况较好，无肝转移和积液控制好的患者生存时间更长。

Objective To explore the prognostic factors in patients with gastric cancer （GC） or adenocarcinoma of the esophagogastric junction （AEG） combined with malignant pleural and/or abdominal effusion. Methods Clinicopathological data of 111 GC or AEG patients with malignant pleural and/or abdominal effusion treated in our hospital from January 2001 to December 2010 were retrospectively analyzed. Results The median survival time for the whole group of 111 patients was 6 months. Effusion disappeared in 12 patients, was reduced in 36 cases, with no changes in 15 cases, and increased in 48 patients. The effusion control rate was 56.8%. Effusion was better controlled in female patients, with simple abdominal ascites, Karnovsky performance scores ≥ 80, with no liver metastases, effusion at initial diagnosis, and effective response to systemic chemotherapy. Univariate analysis showed that patients of female sex, Karnovsky performance scores≥ 80, effusion present at initial diagnosis, simple abdominal ascites, minimal volume of effusion, absence of liver metastasis, control of effusion, initial treatment with effusions and effective response to systemic chemotherapy, normal hemoglobin, albumin, direct and indirect bilirubin levels showed better prognosis （ all P 〈 0.05）. Multivariate analysis showed that liver metastases, control of effusions were independent prognostic factors in patients with gastric cancer and adenocarcinoma of the esophagogastric junction （ all P 〈 0.05）. Conclusions Female patients, simple abdominal ascites, KPS scores ≥80, ascites at initial diagnosis, no liver metastases and effective systemic chemotherapy seem to have a better control of the malignant effusion. Patients with no liver metastases and effective control of effusion have a longer survival time.