胃癌化疗中急性上消化道出血患者的生存预后分析

Prognosis of Gastric Cancer Patients with Acute Upper Gastrointestinal Hemorrhage During Chemotherapy

[目的]分析胃腺癌合并急性非手术相关上消化道出血患者的预后特征,分析化疗中急性上消化道出血患者的生存情况。[方法]回顾性收集中国医学科学院肿瘤医院2010—2018年收治的胃腺癌合并急性非手术相关上消化道出血患者的临床诊疗信息,专人电话随访患者的生存状态。采用SPSS软件进行数据库建立和分析,生存分析及其相关危险因素研究应用Cox比例风险模型。[结果]82例患者,中位年龄59岁(29~86岁),男女比例2.15∶1。淋巴结转移70例(85.4%),Ⅲ~Ⅳ期71例(86.6%)。初次诊断胃癌时出现上消化道出血48例(58.5%),化疗中出现上消化道出血29例(35.4%)。出血后接受手术切除31例(37.8%)。82例患者的中位总生存时间(over survival,OS)12.0个月,化疗中出血OS差于非化疗中出血者,3年OS率分别为3%和21%(P=0.039)。年龄≤40岁患者生存差于>40岁者,中位OS分别为6.5个月和12.0个月(P=0.034)。出血后接受手术治疗的患者生存明显优于未行手术者,根治术、姑息术和未手术患者的3年OS分别为50%、9%和2%(P<0.001)。化疗中出血和出血后未接受手术切除是影响胃癌合并非手术相关急性上消化道出血患者生存的独立不良预后因素。[结论]化疗中出现急性上消化道出血的胃癌患者预后差,化疗中应积极预防上消化道出血的发生,合并急性非手术相关上消化道出血的胃癌,如果为潜在可根治性切除病变,建议积极手术治疗。

[Purpose]To evaluate the prognosis of gastric adenocarcinoma patients with acute upper gastrointestinal hemorrhage during chemotherapy.[Methods]The clinical data of 82 gastric adenocarcinoma patients with acute non-operative upper gastrointestinal bleeding admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences from 2010 to 2018 were analyzed retrospectively.The survival status of patients determined by a telephone follow-up.Survival analysis and identification of related risk factors were performed by Cox,s proportional hazards model using the SPPS software.[Results]The median age of patients was 59 years(range:29-86 years).There were 70 cases(85.4%)of lymph node metastasis,71 cases(86.6%)ofⅢ~Ⅳstage.Forty-eight patients(58.5%)had upper gastrointestinal bleeding at the first diagnosis of gastric cancer,29 cases(35.4%)had upper gastrointestinal bleeding during chemotherapy.Thirty-one patients(37.8%)were treated by surgical resection after bleeding.The median overall survival time(OS)was 12.0 months.The 3-year OS of patients with bleeding during the chemotherapy was shorter than that in patients without bleeding(3%vs 21%,P=0.039).The OS of patients aged≤40 years old was shorter than that of patients aged>40 years(6.5 months vs 12.0 months,P=0.034).The survival rate of patients who received surgical treatment after bleeding was significantly higher than in those who did not;the 3-year OS of patients subjected to the radical operation,palliative operation,and no operation was 50%,9%,and 2%,respectively(P<0.001).Bleeding during chemotherapy and no surgical resection after bleeding were independent adverse prognostic factors in gastric cancer patients with non-operative acute upper gastrointestinal bleeding.[Conclusion]Acute upper gastrointestinal bleeding during the chemotherapy in gastric cancer patients predicts poor prognosis and should be actively prevented.If the gastric cancer is resectable,active radical surgery is recommended.