胃癌同时性肝转移患者不同治疗方法的疗效比较

Comparison of clinical efficacy of different treatment methods for synchronous liver metastasis from gastric cancer

目的评价不同治疗方案对胃癌同时性肝转移的疗效。方法回顾性分析解放军总医院1998年1月至2012年11月收治的271例胃癌同时性肝转移患者的临床病理资料，其中单纯接受手术治疗者34例（手术组），单纯接受化疗者103例（化疗组），接受综合治疗者134例（综合治疗组）。通过随访比较3组接受不同治疗方案患者的预后情况。结果手术组中位生存期为8（3—41）个月，1、3、5年生存率分别为32．4％、2．9％和0；化疗组中位生存期为7（3-50）个月，1、3、5年生存率分别为21．1％、1．1％和0；综合治疗组中位生存期为11（3—84）个月，1、3、5年生存率分别为50．0％、5．0％和O．8％；3组比较，差异有统计学意义（P〈0．05）；手术组与化疗组比较、手术组与综合治疗组比较以及化疗组与综合治疗组比较，差异均有统计学意义（均P〈0．05）。淋巴结转移程度、治疗方式和肝转移灶是否局部处理是影响胃癌同时性肝转移患者生存期的独立预后因素。结论以手术为基础的多学科综合治疗可以改善胃癌同时性肝转移患者的预后。

Objective To evaluate the efficacy of different treatments for synchronous liver metastasis from gastric cancer. Methods Clinicopathological and follow-up data of 271 patients with synchronous liver metastasis from gastric cancer between January 1998 and November 2012 were analyzed retrospectively. Among 271 patients, 34 received surgery alone, 95 received chemotherapy alone, and 120 received combined therapy. The prognosis was compared. Results The median survival time was 8 months （3-41 months） in the surgery group and the cumulative 1-, 3- and 5-year survival rates were 32.4%, 2.9% and 0. The median survival time was 7 months （3-50 months） in the chemotherapy group and the cumulative 1-, 3- and 5-year survival rates were 21.1%, 1.1% and 0 respectively. The median survival time was 11 months （3-84 months） in the combined group and the cumulative 1-, 3- and 5-year survival rates were 50.0%, 5.0% and 0.8% respectively. The differences among groups were all statistically significant （all P〈0.05）. Extent of lymph node metastasis, therapeutic strategies, and liver metastasis management were significantly independent prognostic factors for synchronous liver metastasis from gastric cancer. Conclusions Comprehensive treatment based on operation may improve the long-term survival of patients with synchronous liver metastasis from gastric cancer.