胃癌恶性腹水患者的临床特征及预后分析223例

Clinicopathological features and prognostic factors of gastric cancer patients with malignant ascites:Analysis of 223 cases

目的:探讨胃腺癌恶性腹水的临床病理特征和预后因素.方法:回顾性研究2008-01/2012-12收治的223例胃腺癌恶性腹水患者临床的资料,采用Kaplan-Meier法进行生存分析,预后因素的单因素分析采用Log-rank检验,多因素分析采用Cox回归模型.结果:223例患者,占我院同期收治胃癌病例的6.2%(223/3612),中位年龄52岁(20-81岁),青年胃癌50例(22.4%),老年胃癌38例(17.0%).近端胃癌22例(9.9%),全胃癌12例(5.4%).177例(79.4%)患者病理分化程度为低分化腺癌或未分化腺癌.97例(43.5%)患者在诊断胃癌时即有腹水,122例(54.7%)患者有胃癌手术史,148例(66.4%)患者接受了化疗.无一例其他疾病导致的死亡,中位总生存期4.9 mo,1年生存率12.6%(28/223).单因素分析显示:ECOG评分、以腹水起病,胃癌手术史、胆红素水平、合并其他部位转移以及是否接受化疗是影响患者预后的因素(均P<0.05).多因素分析显示,ECOG评分,以腹水起病,接受化疗,合并其他部位转移是影响患者预后的独立因素(均P<0.05).结论:以腹水起病、行为评分差和合并其他部位转移的胃癌恶性腹水患者预后较差,进行腹腔化疗和全身化疗能延长患者的生存时间.

AIM： To analyze the Cllmcopatnologlcai features and prognostic factors of gastric cancer patients with malignant ascites. METHODS： Clinicopathological data for 223 gas- tric cancer patients with malignant ascites treated at the Jiangxi Provincial Tumor Hospital between January 2008 and December 2012 were retrospec- tively analyzed. Survival analysis was conducted using Kaplan-Meier method. Factors influencing survival were analyzed using univariate （Log- rank） and multivariate （Cox） models. RESULTS： A total of 223 patients （95 females and 128 males, median age, 52 years） were in- cluded, accounting for 6.2% of all gastric cancer cases treated at our hospital during the same period. Among them, 50 （22.4%） were young, 38 （17.0%） were senile, 122 （54.7%） underwent cu- rative gastric resection or cytoreductive surgery, 97 （43.5%） presented with malignant ascites at the initial diagnosis of gastric cancer, and 148 （66.4%） received systematic and/or intraperito- neal chemotherapy. Proximal gastric cancer was diagnosed in 22 cases （9.9%） and whole stomach cancer in 12 cases （5.4%）. Approximately 79.4% （177/223） of cases were diagnosed with poorly differentiated adenocarcinoma or undifferenti- ated adenocarcinoma. After a median follow-up period of 9.7 months, it was found that the me- dian survival following diagnosis of malignant ascites was 4.9 months, and the overall one-year survival rate was 12.6%. Univariate analysis re- vealed that ECOG score, presence of malignant ascites at the initial diagnosis of gastric cancer, history of gastric cancer surgery, total bilirubin level, presence of metastasis in other site（s）, and chemotherapy were significant factors affecting the survival （all P 〈 0.05）. Multivariate analysis showed that ECOG score （P = 0.01）, presence of malignant ascites at the initial diagnosis of gas- tric cancer （P = 0.001）, presence of metastasis in other site（s） （P = 0.002） and chemotherapy （P 〈 0.001） were independent prognostic factors. CONCLUSION： The survival of gastric cancer patients with malignant ascites is relatively short. Worse ECOG score, presence of malignant ascites at the initial diagnosis and presence of metastasis in other site（s） are associated with poor prognosis in gastric cancer patients with malignant ascites, and the survival time could be prolonged by systematic and intraperitoneal chemotherapy.