145例晚期胃癌姑息性放疗患者的临床病理特征及预后分析

The prognosis and clinicopathological characteristics of 145 advanced gastric cancer with palliative radiotherapy

目的分析晚期胃癌姑息性放疗患者的临床病理特征和预后。方法回顾性分析2000年1月至2010年12月于本院接受姑息性放疗的145例晚期胃腺癌患者的临床病理资料,分析影响晚期胃癌姑息性放疗患者生存时间及预后的因素。结果 145例接受姑息性放疗的晚期胃癌患者中,共有138例患者在放疗前后或同时接受化疗。全组患者中位生存时间为16.4个月(95%CI:13.8～18.9)。多因素分析显示:放疗前化疗疗效、放疗后疾病控制情况是影响预后的独立因素。最常见的姑息性放疗部位为淋巴结(共77例,53.1%)。30例一线化疗稳定后行淋巴结放疗的患者与同期匹配的53例单纯化疗患者比较,前者无进展生存时间明显延长(9.9个月∶6.1个月,P=0.018),二者的总生存时间无显著差异(15.4个月∶14.5个月,P=0.383)。结论根据患者具体情况采用姑息性放化疗联合治疗,可以获得较长的生存时间。对于存在淋巴结转移的患者,与单纯一线化疗相比,一线化疗稳定后针对淋巴结放疗可以延长患者的疾病控制时间,患者总生存时间有延长趋势。

Objective To evaluate the clinicopathological characteristics and prognosis of advanced gastric cancer with palliative radiotherapy. Method From January 2000 to December 2010, 145 patients with advanced gastric adenocarcinoma in our hospital were retrospectively reviewed. All the patients were treated with radiotherapy （RT） alone or combined with chemotherapy. The clinicopathological data and follow-up data were collected for analysis. Result 138 out of 145 patients with advanced gastric cancer received palliative RT with chemotherapy sequencially or concurrently. The median overall survival for the entire cohort was 16.4 months （95%CI： 13.8 ~ 18.9）. In multivariate analysis, the response of RT and the response of chemotherapy before RT were predominantly associated with survival. The most common site for RT was local lymph nodes （77 cases, 53.1%）. Median progression free survival was 9.9 months in patients with first-line chemotherapy followed by RT to the lymph node compared with 6.1 months for the chemotherapy alone （P = 0.018）, the overall survival between them was not significantly different （15.4 months ： 14.5 months, P = 0.383）. Conclusion Palliative RT can improve the overall survival in advanced gastric cancer. First-line chemotherapy followed by RT to the local lymph node results in significantly better progression free survival.