Ⅲ期胃癌根治术后含铂方案辅助化疗患者的预后分析

Prognostic analysis of 58 patients with stageⅢreceiving platinum-based chemotherapy after radical gastrectomy for gastric cancer

目的探讨Ⅲ期胃癌根治术后含铂方案辅助化疗患者的预后及影响因素。方法收集2015年1月至2016年12月于本院接受根治性胃癌手术和术后含铂方案(顺铂或奥沙利铂)辅助化疗的58例Ⅲ期胃癌患者,随访患者的预后情况,主要研究终点为无病生存期(DFS),次要研究终点为总生存期(OS)。分析相关临床病理特征对Ⅲ期胃癌根治术后含铂方案辅助化疗患者DFS和OS的影响。结果58例患者的中位随访时间为50.4个月,中位DFS为41.9个月,中位OS未达。单因素分析表明,N分期、TNM分期、神经侵犯、脉管侵犯和含印戒细胞癌(SRCC)成分均与DFS和OS有关(P<0.05),而性别、T分期、手术方式、分化程度、含黏液腺癌成分和肿瘤部位与患者预后无关(P>0.05)。多因素分析发现TNM分期(HR=2.983,95%CI:1.735~5.128,P<0.001)和含SRCC成分(HR=2.256,95%CI:1.042~4.884,P=0.039)是影响DFS的独立预后因素;TNM分期(HR=2.588,95%CI:2.260~12.668,P=0.001)和含SRCC成分(HR=2.588,95%CI:1.471~4.552,P<0.001)是影响OS的独立预后因素。结论Ⅲ期胃癌根治术后含铂方案辅助化疗者中TNM分期为ⅢC期、含SRCC成分的预后较差,然而临床上对于分期较晚或SRCC成分患者应加强重视。

Objective To investigate the prognosis and influencing factors of patients with stageⅢgastric cancer receiving platinum-based chemotherapy after radical gastrectomy for gastric cancer.Methods From January 2015 to December 2016,58 patients with stageⅢgastric cancer underwent radical gastrectomy and postoperative adjuvant chemotherapy with cisplatin or oxaliplatin were enrolled.Prognosis of the patients was followed up.The primary endpoint was disease-free survival(DFS),and the secondary endpoint was overall survival(OS).Influence of clinicopathological features on DFS and OS in patients with stageⅢgastric cancer receiving adjuvant chemotherapy with platinum-based regimen after radical gastrectomy were analyzed.Results The median follow-up of 58 patients was 50.4 months.The median DFS was 41.9 months,and the median OS was not reached.Univariate analysis showed that N stage,TNM stage,nerve invasion,vascular invasion and components of signet-ring cell carcinoma(SRCC)were associated with DFS and OS(P<0.05),while gender,T stage,surgical method,differentiation degree,components of mucinous adenocarcinoma and tumor location were not related to prognosis(P>0.05).Multivariate analysis showed that TNM stage(HR=2.983,95%CI:1.735-5.128,P<0.001)and components of SRCC(HR=2.256,95%CI:1.042-4.884,P=0.039)were independent prognostic factors for DFS.TNM stage(HR=2.588,95%CI:2.260-12.668,P=0.001)and components of SRCC(HR=2.588,95%CI:1.471-4.552,P=0.001)were independent prognostic factors for OS.Conclusion The prognosis of patients with TNM stageⅢC and components of SRCC after radical gastrectomy with platinum-based chemotherapy is poor.However,more attention should be paid to patients with late stage or components of SRCC.