胃腺癌和食管胃结合部腺癌非手术相关急性上消化道出血生存分析

Survival analysis of gastric adenocarcinoma and esophageal gastric junction adenocarcinoma with non-operative acute upper gastrointestinal hemorrhage

目的胃癌和食管胃结合部癌位于全球恶性肿瘤发病和死亡的前列。本研究分析合并非手术相关急性上消化道出血胃腺癌和食管胃结合部腺癌患者的生存和预后因素。方法回顾性收集中国医学科学院肿瘤医院2010-01-01-2018-12-30收治的合并急性非手术相关上消化道出血胃腺癌(82例)和食管胃结合部腺癌(28例)患者临床资料,电话随访患者的生存状态。采用SPSS 20.0软件建立数据库并进行统计分析,生存分析及其相关危险因素分析应用Cox比例风险模型。结果 110例患者中,男女比例2.5∶1;年龄20.0~86.0岁,中位年龄61.0岁;根据2018年第8版美国癌症联合会(AJCC)分期标准,Ⅰ~Ⅱ期16例(14.5%),Ⅲ~Ⅳ期94例(85.5%);65例(59.1%)为初诊时出血。出血后接受手术治疗43例(39.1%),其中根治术32例,姑息切除11例。总生存时间(overall survival,OS)0.5~78.0个月,中位OS13.0个月;胃腺癌中位OS为12.0个月;Ⅰ~Ⅱ期中位OS为60.0个月,Ⅲ~Ⅳ期中位OS为11.0个月,差异有统计学意义,P<0.001;合并消化道梗阻或穿孔患者中位OS为5.0个月,无合并消化道梗阻或穿孔者中位OS为14.0个月,差异有统计学意义,P=0.007;出血后行手术者和未手术者中位OS分别为36.0和7.0个月,差异有统计学意义,P<0.001。多因素分析结果提示,Ⅲ~Ⅳ期(HR=6.226,95%CI为1.430~27.111,P=0.015)、合并消化道梗阻或穿孔梗阻(HR=1.875,95%CI为1.082~3.248,P=0.025)和出血后手术治疗(HR=0.340,95%CI为0.187~0.618,P<0.001)是影响此类患者的独立预后因素。结论合并非手术相关急性上消化道出血的胃腺癌和食管胃结合部腺癌患者分期晚、生存期短,尤其合并消化道梗阻或穿孔患者预后差,出血后手术治疗可能改善此类患者生存。

OBJECTIVE The morbidities and mortalities of gastric cancer and esophageal gastric junction cancer are among the highest malignant tumors in the world.This study aimed to explore the survival and prognostic factors of gastric and esophagogastric junction adenocarcinoma patients with non-operative acute upper gastrointestinal haemorrhage.METHODS We retrospectively collected diagnosis and treatment information of patients with gastric and esophagogastric junction adenocarcinoma with acute non-postoperative upper gastrointestinal bleeding in the Cancer Hospital of Chinese Academy of Medical Sciences from 2010-01-01 to 2018-12-30.The survival status of patients was followed up by telephone.SPSS 20.0 software was used for data collection and analysis.We applied Cox proportional-hazards model to analyse survival and related risk factors.RESULTS Totally 110 patients with a male to female ratio of 2.5∶1 and a median age of 61.0 years(20.0-86.0)were selected.According to the eighth edition of the American Cancer Association(AJCC)in2018,16 cases(14.5%)were stageⅠ-Ⅱdisease,94 cases(85.5%)were stageⅢ-Ⅳdisease.Bleeding at initial cancer diagnosis was observed in 65 cases(59.1%)and 43 patients(39.1%)received surgical treatment after bleeding,including32 cases of radical operation and 11 cases of palliative resection.The median overall survival(OS)time was 13.0 months(0.5-78.0).Gastric adenocarcinoma OSwas 12.0 months.Early stage(Ⅰ-Ⅱ)disease OSwas significantly longer than late stage(Ⅲ-Ⅳ)disease(60.0 months vs 11.0 months,P<0.001).The median OS was 5.0 months in patients with digestive tract obstruction or perforation,and 14.0 months in patients without digestive tract obstruction or perforation(P=0.007).The OS of the patients who underwent operation after haemorrhage and those who did not were 36.0 and7.0 months,respectively(P<0.001).Cox multivariate analysis showed that stageⅢ-Ⅳ(HR=6.226,95%CI:1.430-27.111,P=0.015),perforation/obstruction of digestive tract(HR=1.875,95%CI:1.082-3.248,P=0.025)and operation after haemorrhage(HR=0.340,95%CI:0.187-0.618,P<0.001)were the independent prognostic factors for gastric and esophagogastric junction adenocarcinoma patients with non-operative related acute upper gastrointestinal haemorrhage.CONCLUSIONS Gastric and esophagogastric junction adenocarcinoma patients with non-operative acute upper gastrointestinal bleeding exhibited late stage disease and a short OS.The prognosis is especially poor in patients with digestive tract perforation/obstruction.Active surgical treatment after bleeding may affect the survival of patients.