老年进展期胃癌预后的影响因素分析

Analysis of prognostic factors for elderly advanced gastric cancer

目的：探讨老年进展期胃癌患者的预后及影响预后的因素。方法回顾性分析2010年1月至2012年12月174例≥70岁接受化疗的进展期胃癌患者的临床资料，生存分析采用Kaplan-Meier法，多因素分析采用Cox比例风险模型。结果174例患者一线化疗的有效率（RR）为31.5％（51／162），疾病控制率（DCR）为73.5％（119／162），中位生存期（OS）为11.4个月（95％ CI：10.4～12.4月），1年、2年生存率为39.0％和17.0％。两药方案的RR和中位OS高于单药方案（35.8％ vs．17.9％，P＝0.037；14.1个月和7.5个月，P＝0.010），两方案DCR的差异无统计学意义；化疗1～2个周期、3～4个周期、≥5个周期的中位OS分别为7.7个月、13.1个月和21.5个月（ P＜0.001）；仅接受一线化疗132例患者的中位OS为10.7个月，接受二线化疗42例患者的中位OS为16.7个月（ P＝0.006）。 Cox多因素分析显示，ECOG评分、转移个数、癌胚抗原、糖类抗原199、乳酸脱氢酶、化疗周期数和进展后是否接受二线化疗是影响预后的独立因素。结论多周期化疗和一线化疗进展后接受二线化疗可改善老年进展期胃癌患者的预后。

Objective To investigate the prognosis and related influencing factors for elderly advanced gastric cancer. Methods The data of 174 patients over 70 years with advanced gastric cancer who received chemotherapy from January 2010 and December 2012 was reviewed. Kaplan-Meier method was employed to analyze survival and Cox proportional hazard model was used for multifactor analysis.Results The response rate （RR） was 31.. 5%（51/162）and the disease control rate （DCR） was 73.. 5%（119/162）.The median overallsurvival （OS） was 11.. 4 months （95% CI： 10.. 4-12.. 4） and the 1-, 2-year survival rates were 39.. 0% and 17.. 0%. The RR and medianOS of 2-drug therapy were better than those of monotherapy （35.. 8% vs. 17.. 9%, P=0.. 037; 14.. 1months vs. 7.. 5 months,P=0.. 010）, butthe difference of DCR had no significance （P＆gt;0.. 05）. The median OS of patients receiving chemotherapy of 1-2, 3-4 and ＆gt;5 cycles were7.. 7, 13.. 1 and 21.. 5months （P＆lt;0.. 001）. The median OS of receiving first-line therapy alone was shorter than those receiving second-lineafter disease progression （10.. 7 months vs. 16.. 7 months, P=0.. 006）. Cox regression model showed that ECOG score, number of metastat-ic lesions, CEA, CA19-9, lactate dehydrogenase, chemotherapy cycles and the second-line chemotherapy were the independentprognostic factors influencing prognosis. Conclusion Multiple cycles of chemotherapy and the application of second-line chemotherapyafter disease progression may improve the prognosis of elderly patients bearing advanced gastric cancer.