胃癌肺转移患者生存率的影响因素分析

Relevant factors analysis on the survival of gastric cancer patients with lung metastasis

目的探讨胃癌肺转移患者生存率的影响因素。方法回顾性分析天津医科大学肿瘤医院1995年1月至2011年12月收治的64例胃癌肺转移患者的临床病理及随访资料，计算患者的总生存率，分别采用Log．rank检验和Cox比例风险模型对可能影响胃癌肺转移患者生存率的临床病理特征进行单因素和多因素分析。结果全组64例患者的中位生存时间为7月，1、2和3年生存率分别为32．8％、18．8％和7．8％。单因素分析显示，原发肿瘤部位、肺转移类型、合并肺外脏器转移和化疗与患者的预后有关（P〈0．05）。多因素分析结果显示，双侧肺转移（HR=2．093，95％CI：1．092，4．014；P=0．026）和合并肺外脏器转移（HR=2．433，95％CI：1．359—4．358；P=0．003）是影响胃癌肺转移患者生存率的独立危险因素；化疗（HR=0．387，95％CI：0．211～O．710；P=0．002）是独立保护性因素。结论胃癌肺转移患者的总体预后较差，尤其是双侧肺转移或合并肺外脏器转移的患者：接受系统化疗可改善患者预后。

Objective To investigate the factors affecting survival rate in gastric cancer patients with lung metastasis. Methods Clinicopathological and follow-up data of 64 gastric cancer patients with lung metastasis treated at the Cancer Hospital of Tianjin Medical University from January 1995 to December 2011, were retrospectively analyzed. The survival rate was calculated. Univariate and multivariate analysis were performed to find the factors affecting survival rate using Log-rank test and Cox proportional hazards model, respectively. Results The median survival time was 7 months. The 1-, 2- and 3-year survival rates were 32.8%, 18.8% and 7.8% respectively. Univariate analysis showed that primary tumor location, type of lung metastasis, lung metastasis combined with other distant metastasis and chemotherapy were significant factors for prognosis （P 〈 0.05）. Multivariate analysis revealed that bilateral lung metastasis （HR = 2.093, 95% C1：1.092-4.014, P = 0.026） and lung metastasis combined with other distant metastasis （HR = 2.433, 95% CI： 1.359-4.358, P = 0.003） were independent risk prognostic factors, while chemotherapy was independent protective factor （HR=0.387, 95% CI：0.211-0.710, P = 0.002）. Conclusions Prognosis of gastric cancer patients with lung metastasis is quite poor, especially those with bilateral lung involvement and extra-pulmonary metastasis. Systemic chemotherapy may improve the prognosis of these patients.