胃癌肝转移患者的临床特征及预后生存分析

Clinical characteristics and prognosis of patients with liver metastasis from gastric cancer

目的肝是胃癌转移的常见部位,但目前对于出现肝转移的胃癌患者尚无统一治疗规范。文中探讨胃癌肝转移患者的临床特征和预后因素,为提高胃癌肝转移患者诊治水平提供依据。方法对四川省人民医院2009年1月至2014年6月收治的143例胃癌肝转移患者的临床特征及生存资料进行回顾性分析,采用Cox回归模型探讨影响患者预后的独立危险因素。结果 143例胃癌肝转移患者中位生存期为14个月,1、2、3年生存率依次为52.4%、28.7%、12.6%。单因素分析显示,不同原发胃癌组织学分级、肝转移时间、肝转移癌类型、肝外转移情况和治疗方式的胃癌肝转移患者间的生存状况差异有统计学意义(P<0.05)。多元Cox回归分析显示,胃癌组织学分级为低分化或未分化(HR=2.67,95%CI:1.51~4.72)、肝转移癌类型为H2(HR=1.89,95%CI:1.08~3.29)或H3(HR=2.13,95%CI:1.32~3.44)为胃癌肝转移患者预后的独立危险因素;姑息化疗(HR=0.55,95%CI:0.32~0.95)为胃癌肝转移患者预后的独立保护因素。结论胃癌肝转移患者预后较差。胃癌组织学分级低、肝转移癌类型为H2或H3的胃癌肝转移患者预后相对较差。接受姑息化疗的胃癌肝转移患者预后好于接受最佳支持治疗的患者,因此临床上应尽量考虑为使患者提供综合治疗机会。

Objective Liver is a common site of metastasis of gastric cancer and hitherto there has been no uniform treatment for liver metastasis of gastric cancer. This study was to investigate the clinical characteristics and prognostic factors of liver metastasis of gastric cancer in order to provide some evidence for the improvement of the diagnosis and treatment of the disease. Methods We ret- rospectively analyzed the clinical characteristics and survival data of 143 patients with liver metastasis of gastric cancer treated in our hospital between March 2007 and September 2012. We investigated the independent risk factors affecting the prognosis of the disease using the Cox Regression Model. Results Seventy-five （52.4%） of the 143 patients survived for 12 months, 41 （28.7%） for 24 months, and 18 （ 12.6% ） for 36 months, with a median survival time of 14 months. Univariate analysis revealed statistically significant differences in the survival time among the patients with different histological grades of primary gastric cancer, time of liver metastasis, types of metastatic liver cancer, extra-liver metastasis, and treatment methods （P〈0.05）. Multivariate Cox regression analysis showed the histological grade of gastric cancer to be low- or non-differentiation （HR = 2.67, 95% CI： 1.51-4.72） and the type of liver metastatic cancer to be H2 （HR= 1.89, 95% CI： 1.08-3.29） or H3 （HR=2.13, 95% CI： 1.32-3.44）, which were independent risk factors affecting the prognosis of liver metastasis of gastric cancer, while palliative chemotherapy （HR= 0.55, 95% CI： 0.32-0.95） was an independent protective factor of its prognosis. Conclusion Patients with liver metastasis from gastric cancer usually have a poor prognosis, especially those with histologically low-grade gastric cancer or type-H2 or -H3 liver metastatic cancer. The prognosis of the patients undergoing palliative chemotherapy may have a better prognosis than those receiving best supportive care. A comprehensive therapy should be recommended to patients with liver metastasis from gastric cancer.