进展期胃癌患者行新辅助化疗的临床疗效及影响因素分析

Clinical efficacy and risk factors of neoadjuvant chemotherapy in patients with advanced gastric cancer

目的观察进展期胃癌新辅助化疗临床疗效并分析其影响因素。方法回顾146例接受新辅助化疗的进展期胃癌患者的临床病理资料,采用多因素logistic回归分析影响其临床疗效的相关因素。结果进展期胃癌患者新辅助化疗总有效率为65.07%。有效组的肿瘤直径≤5cm、管状腺癌、T3分期和淋巴结无转移的比例明显高于无效组,差异均有统计学意义(χ^2分别=5.40、7.92、4.45、4.42,P均<0.05)。两组患者之间的性别比、年龄、肿瘤部位、分化程度和化疗方案比较,差异均无统计学意义(χ^2分别=0.28、0.05、2.25、1.76、1.28,P均>0.05)。多因素分析结果显示,肿瘤直径≤5cm和T3分期是进展期胃癌新辅助化疗疗效的保护因素(OR分别=0.42、0.50,P均<0.05),而淋巴结转移是新辅助化疗疗效的危险因素(OR=3.27,P<0.05)。新辅助化疗主要不良反应为白细胞减少和口腔黏膜炎等,并且以1~2级为主。结论新辅助化疗治疗进展期胃癌疗效明显且不良反应较轻,影响其疗效的主要因素为肿瘤直径、T分期及淋巴结转移情况。

Objective To observe the clinical efficacy and risk factors of neoadjuvant chemotherapy in patients with advanced gastric cancer.Methods The clinical data of 146 patients with advanced gastric cancer who underwent neoadjuvant chemotherapy were retrospectively analyzed.The influence factors for clinical efficacy were analyzed by multivariate logistic regression.Results The total effective rate of neoadjuvant chemotherapy in patients with advanced gastric cancer was 65.07%.The proportions of tumor diameter≤5 cm,tubular adenocarcinoma,T3 stage and lymph node non-metastasis in the effective group were significantly higher than those in the invalid group(χ^2=5.40,7.92,4.45,4.42,P<0.05).There was no significant difference in sex,age,tumor location,differentiation degree and chemotherapy regimen between the two groups(χ^2=0.28,0.05,2.25,1.76,1.28,P>0.05).Multivariate logistic analysis showed that tumor diameter≤5 cm and T3 stage were protective factors for the efficacy of neoadjuvant chemotherapy for advanced gastric cancer(OR=0.42,0.50,P<0.05),while lymph node metastasis was risk factor(OR=3.27,P<0.05).The main adverse reactions of neoadjuvant chemotherapy were leukopenia and oral mucositis,mainly grade 1 or grade 2.Conclusion Neoadjuvant chemotherapy in the treatment of advanced gastric cancer is effective and has less adverse reaction.The main influencing factors for the efficacy of neoadjuvant chemotherapy for advanced gastric cancer are tumor diameter,T stage and lymph node metastasis.