65岁及以上晚期胃癌患者预后多因素分析

Multivariate analysis of prognostic factors in patients aged 65 years and over with advanced gastric cancer

目的分析不同治疗方法对老年晚期胃癌患者生存期的影响，为治疗老年晚期胃癌提供指导。方法回顾分析江苏省宜兴市人民医院2009年1月至2013年10月收治的符合入组条件的146例老年晚期胃癌患者，详细记录患者的临床资料，并随访患者的总生存时间，利用Log—rank检验单因素分析及COX比例风险模型多因素分析影响老年晚期胃癌患者预后的相关因素。结果全组146例老年晚期胃癌病例1、2和3年生存率分别为33．6％、11．0％、2．1％，中位生存时间10．3个月。Log—rank检验单因素分析提示Karnofsky（KPS）评分、分化程度、转移部位数、恶性浆膜腔积液、化疗、中医中药与老年晚期胃癌患者预后相关（P〈0．05）；COX比例风险模型多因素分析提示KPS评分（HR=1．575，95％CI：1．094～2．267，P=0．015）、分化程度（HR=0．499，95％CI：0．340～0．732，P〈0．001）、恶性浆膜腔积液（HR=0．516，95％CI：0．356～0．748，P〈0．001）、化疗（HR=1．669，95％CI：1．185～2．35I，P=0．003）、中医中药（HR=1．793，95％CI：1．237～2．600，P=0．002）是影响老年晚期胃癌患者预后的独立因素（P〈0．05）。结论老年晚期胃癌患者预后较差，尤其是KPS评分较低、分化程度较差、有恶性浆膜腔积液患者，化疗及中医中药可改善预后。

Objective To analyze the effects of different therapies on patient survival,to explore the related prognostic factors in elderly patients with advanced gastric cancer, and to provide recommendations for the treatment of such patients. Methods Retrospective analysis was conducted on 146 elderly patients with advanced gastric cancer hospitalized from January 2009 to October 2013 in Yixing People＇s Hospital of Jiangsu Province. Detailed clinical data were recorded, and patients were followed up during the total survival time. Univariate analysis with the Log-rank test and multivariate analysis with the COX proportional hazard model were utilized to examine the related prognostic factors in elderly patients with advanced gastric cancer. Results The 1-,2-,3 year survival rates of 146 elderly patients with advanced gastric cancer were 33.6%, 11.0% ,and 2.10% ,respectively,and the median survival time was 10.3 months. The Log-rank test showed that Karnofsky （KPS） score, differentiation degree, number of metastatic sites, malignant serous effusion, chemotherapy, and traditional Chinese medicine （TCM） were associated with the prognosis of elderly patients with advanced GC （all P〈0.05）. Multivariate analysis by the COX proportional hazard model showed that KPS score （ HR= 1. 575,95 % CI： 1. 094-2. 267, P= 0. 015 ）, differentiation degree （ HR= 0. 499,95 CI：0. 340-0. 732, P〈0. 001）, malignant serous effusion （ HR= 0. 516,95% CI： 0. 356-0. 748, P〈 0. 001） ,chemotherapy （HR=1. 669,95% CI：1. 185-2. 351,P=0. 003）,and TCM （HR= 1. 793,95% CI： 1. 237-2. 600, P=0. 002） were independent factors related to the prognosis of elderly patients with advanced GC. Conclusions The prognosis of elderly patients with advanced gastric cancer is poor, especially for patients with a low KPS score, a poor differentiation degree, or malignant serous effusion. Chemotherapy and TCM can improve the prognosis.