姑息性胃切除联合术后化疗评分在腹膜转移的胃癌患者预后评估中的临床意义

The clinical impact of score which was caculated by palliative gastrectomy combined with postoperative chemotherapy in gastric cancer patients with peritoneal metastasis

目的:探讨姑息性胃切除联合术后化疗评分在腹膜转移的胃癌患者预后评估中的临床意义。方法:回顾性分析2010年1月至2016年12月7年间收治的287例发生腹膜转移的胃癌患者的临床病理资料。通过χ~2检验分析评分与患者临床病理因素间的关系。通过Kaplan-Meier法绘制生存曲线,Log-rank检验比较患者生存率的差异;采用Cox比例风险回归模型对患者进行预后分析。结果:与评分中得分为2分和1分的患者相比,得分为0分的患者肿瘤侵润至T_(4b)期的患者较少[31%(18/58)比50.8%(63/124)、56.2%(59/105),P=0.039]。全组患者的中位生存时间仅为8.7月。对患者进行单因素预后分析结果显示,血清白蛋白浓度(≤40 g/L),腹水,腹膜转移范围较大,肿瘤T分期较晚,评分得分较高的患者预后较差(均P<0.05)。将上述因素纳入Cox多因素分析结果显示:评分[HR(95%CI):1.384(1.165～1.644),P=0.000],血清白蛋白浓度[HR(95%CI):0.759(0.593～0.971),P=0.028],肿瘤T分期[HR(95%CI):1.493(1.216～1.832),P=0.000]是患者预后的独立危险因素。结论:评分对于胃癌伴腹膜转移患者的预后生存评估具有重要的临床意义。

Objective:To evaluate clinical value of score in gastric cancer patients with peritoneal metastasis.Methods:The retrospective research enrolled 287 patients with gastric cancer who were affirmed peritoneal metastasis through operation from January 2010 to December 2016.The categorical variables were tested by Chi-square.Survival analysis was analyzed by Kaplan-Meier method and Log-rank test was utilized to compare the survival difference.The prognosis of the patients was peformed by univariate and multivariate Cox proportional hazards regression model.Results:Compared with the patients with scores of 2 and 1 in the score,the patients with T 4b staging in 0 score were fewer[31%(18/58)to 50.8%(63/124),56.2%(59/105),P=0.039].The median survival time for all patients was 8.7 months.Univariate analysis revealed that,lower serum albumin level(≤40 g/L),ascites,larger range of peritoneal metastasis,more late T staging,higher scores were positively associated with poor prognosis(all P<0.05).Multivariate analysis demonstarted that score[HR(95%CI):1.384(1.165~1.644),P=0.000],serum albumin level[HR(95%CI):0.759(0.593~0.971),P=0.028],T staging[HR(95%CI):1.493(1.216~1.832),P=0.000]were independent risk factors for the patients with peritoneal metastasis.Conclusion:The score can act as a predictor of prognosis for gastric cancer patients with peritoneal metastasis.