各类化疗药物对胃恶性肿瘤肝转移患者治疗效果的对比分析研究

Prognostic analysis of effectiveness of various chemotherapy drugs on patients with hepatic metastasis from gastric cancer

目的探讨各种化疗药物(紫杉醇类、铂类、伊立替康、氟尿嘧啶类)对胃癌肝转移患者无进展生存期(progression-freesurvival,PFS)与总生存(overall survival,OS)的影响,分析药物疗效是否具有针对年龄、性别、远处转移灶数量和饮酒史的特异性。方法回顾性分析2004年3月至2019年3月在本院接受治疗的66例胃癌肝转移患者的资料。Kaplan-Meier法行单因素生存分析。结果66例胃癌肝转移患者未化疗组OS为4.9个月(95%CI:2.3~7.5),化疗组OS为12.3个月(95%CI:8.5~16.1)。单因素分析显示,紫杉醇类(OS=13.9个月,95%CI:8.2~19.6,P=0.0 022),铂类(OS=14.6个月,95%CI:9.3~19.8,P=0.0 011),氟尿嘧啶类(OS=13.5个月,95%CI:9.2~17.8,P=0.0 014)可以显著延长OS。此外,紫杉醇类(P=0.0 374)与铂类(P=0.0 255)对有饮酒史的患者有更显著效果,氟尿嘧啶类对无肝外远处转移的患者有更显著效果(P=0.0 473),能够明显延长其OS。结论使用紫杉醇类、铂类与氟尿嘧啶类化疗药物能够显著延长胃癌肝转移患者OS,紫杉醇类与铂类对具有饮酒史的胃癌肝转移患者具有更佳疗效,氟尿嘧啶类对没有肝外远处转移的胃癌肝转移患者具有更佳疗效。

Objective To investigate the prognostic factors of patients with hepatic metastasis from gastric cancer,who are under chemotherapy utilizing taxanes,platinum complexes,irinotecan or fluropyrimidines,along with the influences of sex,age,number of distant metastatic sites and history of alcohol intake.Method The clinico-pathological data of 66 patients with hepatic metastasis from gastric cancer who were admitted to the Nanjing First Hospital from March 2004 to March 2019 were retrospectively analyzed.Kaplan-Meier analysis was used to estimate the overall survival(OS).Result In all 66 cases of gastric cancer patients with liver metastasis,the overall survival was 4.9 months(95%CI:2.3~7.5)in the non-chemotherapy group and 12.3 months(95%CI:8.5~16.1)in the chemotherapy group.Univariate analysis showed that Taxanes(OS=13.9 months,95%CI:8.2~19.6,P=0.0 022),platinum complexes(OS=14.6 months,95%CI:9.3~19.8,P=0.0 011)and fluropyrimidines(OS=13.5 months,95%CI:9.2~17.8,P=0.0 014)can significantly increase the overall survival of those patients.Also,taxanes(P=0.0 374)and platinum complexes(P=0.0 255)are found to be significantly more effective when taken by those with a history of alcohol intake,while fluropyrimidines are more effective with patients who not have distant metastasis sites outside of the liver(P=0.0 473).Conclusion Utilizing chemotherapy drugs like taxanes,platinum complexes and fluropyrimidines can offer extended overall survival to patients with hepatic metastasis from gastric cancer.Also,platinum complexes can be especially effective when applied to patients with a history of alcohol intake while fluropyrimidines are more effective with patients who have no distant metastasis sites outside of the liver.