影响老年进展期胃癌患者化疗远期预后的危险因素分析

Risk factors of long-term prognosis in elderly patients with advanced gastric cancer after chemotherapy

目的探讨影响老年进展期胃癌患化疗远期预后的危险因素。方法选择2013年1月至2015年10月广东省惠州市第六人民医院收治的老年进展期胃癌患者200例。按照患者病情及肿瘤特点,选择不同方案进行新辅助化疗,平均化疗4个周期。记录所有研究对象随访3年生存率;分析影响老年进展期胃癌患者3年生存率的相关因素;采用Logistic回归方法分析影响老年进展期胃癌患者3年生存率的危险因素。结果随访3年,生存121例,死亡79例。随访3年生存率为60. 5%(121/200)。不同性别、临床分期、肿瘤部位、淋巴结清扫范围及是否合并高血压及是否存在远处转移患者3年生存率比较差异均无统计学意义(均P> 0. 05)。肿瘤直径> 7 cm患者3年生存率低于肿瘤直径≤7 cm患者,低分化患者3年生存率低于中高分化患者,合并糖尿病患者3年生存率低于未合并糖尿病患者,合并淋巴结转移患者3年生存率低于无淋巴结转移患者[53. 4%(63/118)比70. 7%(58/82)、48. 8%(59/121)比78. 5%(62/79)、45. 6%(26/57)比66. 4%(95/143)、49. 6%(67/135)比83. 1%(54/65)],差异均有统计学意义(均P <0. 05)。将上述单因素分析具有统计学意义的参数纳入多因素分析,结果显示,肿瘤直径> 7 cm、低分化和淋巴结转移为影响老年进展期胃癌患者3年生存率的危险因素(均P <0. 05)。结论老年进展期胃癌患者化疗远期预后的影响因素较多,其中肿瘤直径、分化程度和淋巴结转移为其危险因素。

Objective To investigate the risk factors of long-term prognosis in elderly patients with advanced gastric cancer after chemotherapy. Methods Two hundreds elderly patients with advanced gastric cancer admitted to the Sixth People’s Hospital of Huizhou,Guangdong Province from January 2013 to October 2015 were recruited. According to patients’ condition and tumor characteristics,different regimens were applied for neoadjuvant chemotherapy,with an average of 4 cycles. All patients were followed up for 3 years;related factors of the 3-year survival rate of elderly patients with advanced gastric cancer were analyzed;risk factors of the 3-year survival rate were analyzed by logistic regression. Results Follow-up for 3-year;121 patients survived and79 patients died;the 3-year survival rate was 60. 5%( 121/200). There were no significant differences of the3-year survival rate among patients with different gender,clinical stage,tumor location,lymph node dissection area,hypertension and distant metastasis( all P > 0. 05). Lower 3-year survival rates were observed in patients with tumor diameter > 7 cm,poor differentiated tumor,diabetes mellitus and lymph node metastasis[53. 4%(63/118) vs70. 7%(58/82),48. 8%(59/121) vs 78. 5%(62/79),45. 6%(26/57) vs 66. 4%(95/143),49. 6%(67/135) vs83. 1%( 54/65)],the differences were statistically significant( all P < 0. 05). Multivariate logistic regression showed that tumor diameter > 7 cm,poor differentiation and lymph node metastasis were risk factors of the 3-year survival in elderly patients with advanced gastric cancer( all P < 0. 05). Conclusion There are many factors influencing the long-term prognosis in elderly patients with advanced gastric cancer after neoadjuvant chemotherapy;tumor diameter,differentiation and lymph node metastasis are the risk factors.