不同方案治疗胃癌同时性肝转移的疗效比较及预后危险因素分析

Comparison of clinical efficacy of different treatment methods for synchronous liver metastasis from gastric cancer and regression analysis of prognostic risk factors

目的：探讨手术、化疗、介入及综合治疗对胃癌同时性肝转移患者的临床效果，并分析预后危险因素。方法：回顾性分析106例胃癌同时性肝转移患者的J陆床资料j比较接受不同方案治疗的生存率，并行单因素和多因素分析预后危险因素。结果；手术组中位生存悯为35（3-65）个月，1、3、5年累计生存率分别为68．6％、45．2％和12．3％．化疗组中位生存时间为16（3—71）个月，1、3、5年累计生存率分别为60．4％、48．4％和9．8％；介入组中位生存时间为34（3—66）个月，1、3、5年累计生存率分别为62．3％、39．7％和11．5％；综合治疗组中位生存日寸间为39（3—84）个月，1、3、5年累计生存率分别为85．6％、55．9％和19．2％。4组生存率比较差异有统计学意义（x2=17．488，P〈0．01）。单因素分析结果显示肝外转移、肝转移程度、肝转移灶直径、淋巴结转移、胃切除术、TACE、化疗与胃癌同时性肝转移患者生存期有关（P〈0．05）。多因素分析结果显示，胃癌同时性肝转移患者生存期的独立预后因素包括肝外转移、肝转移程度、淋巴结转移、胃切除术、TACE及化疗（P〈0．05）.结论：综合治疗是胃癌同时性肝转移最有效的治疗手段，可延长患者生存期，改善预后。

Objective： To explore the therapeutic effect of different regimens for the treatment of patients with synchronous liver metastasis from gastric cancer and the risk factors of prognosis. Methods： Clinical and follow-up data of 106 patients with synchronous }iver metastasis from gas- tric cancer between June 2014 to July 2008 were analyzed retrospectivel. The survival rates of pa- tients with different treatments were compared, and the prognostic risk factors were analyzed by single factor and multiple factors analysis. Results： The median survival time was 35 months （3 - 65 months） in the surgery group and the cumulative 1-year,3-year and 6-year survival rates were 68.6% ,45.2% and 12,3%. The median survival time was 16 months （3-71 months） in the chemotherapy group and the cumulative 1-year,3-year and 5-year survival rates were 60.4%, 48,4%and 9.8%respectively. The median survival time was 34 months （3-66 months） in the inter- ventionat therapy group and the cumulative 1-year,3-year and 5-year survival rates were 62.3%, 39.7%and 11.5%respectively. The median survival time was 39months（3-84 months） in the com- bined group and the cumulative 1-year,3-year and 5-year survival rates were 85.6% ,55.9% and 19.2 % respectively. The differences among four groups were all statistically significant （ X 2= 17.488, P〈0.01）. Univariate analysis showed extrahepatic metastasis, extent of liver metastasis, liver metastasis tumor size, lymph node transfer, gastrectomy, TACE, chemotherapy were correlated with survival time of patients with synchronous liver metastasis from gastric cancer（P〈0.05）. Multivariate analysis showed extrahepatic metastasis, extent of liver metastasis, lymph node transfer, gastrecto- my, TACE, chemotherapy were significantly independent prognostic factors for synchronous liver metastasis from gastric cancer （P〈0.05）. Conclusion： Combined therapy is the most effective method for the treatment of patients with synchronous liver metastasis from gastric cancer. It can prolong the survival time and improve the prognosis of them.