初始不可切除胃癌患者转化治疗疗效及预后分析

Effect and prognostic factors of coversion therapy for patients with inoperable advanced gastric cancer

目的探讨初始不可切除胃癌患者行转化治疗的临床疗效及其预后。方法收集2017年5月-2019年5月安徽医科大学附属安庆医院肿瘤外科收治的33例难以切除局部进展期(Ⅲb/c期)或不可切除的IV期胃癌患者的临床资料,其中男性25例,女性8例,平均年龄65.48岁,通过对资料中患者转化治疗疗效及术后病理等因素进行统计,用单因素及多因素分析的方法评价其与患者预后的相关性。结果33例患者中有2例患者经转化治疗达到完全缓解,18例患者达到部分缓解,客观有效率60.6%,共有20例患者接受手术治疗,17例患者达到R0切除,33例患者中位总生存期(mOS)(18.6±4.5)个月,未手术患者mOS(11.2±2.5)个月,手术患者mOS(25.7±4.3)个月(P=0.004)。按分型分析,不可切除晚期胃癌患者mOS(11.3±0.35)个月,难以切除局部进展期胃癌患者mOS(18.9±5.5)个月(P=0.568)。单因素分析显示术前化疗周期≥4周预后优于小于4周期(P=0.003)、TRG评分1/2级患者预后较好(P=0.001)、阳性淋巴结≥7枚是影响手术组患者预后的危险因素(P=O.001)。多因素回归分析结果显示阳性淋巴结≥7枚是影响手术组患者预后的独立因素(P=0.013)。结论对于难以切除的局部进展期胃癌及不可切除的IV期胃癌患者,转化治疗病情缓解后行手术治疗能提高患者生存期,充分的术前化疗可提高患者预后,化疗周期至少4周期以上。

Objective To evaluate the clinical efficacy and prognostic factors in patients with stageⅢb/c or IV inoperable advanced gastric cancer.Methods The clinical data of 33 patients with unresectable locally advanced(stageⅢb/c)or unresectable stage IV gastric cancer were collected from May 2017 to may 2019 in the Department of Surgical Oncology,Anqing Hospital affiliated to Anhui Medical University,Among them,there were 25 males and 8 females with an average age of 65.48±9.00 years.According to the data of patients with conversion therapy efficacy and postoperative pathology and other factors for statistics,using univariate and multivariate analysis method to evaluate its correlation with the prognosis of patients.Results Of 33 patients,2 patients were complete remission,18 patients were partial remission,the objective response rate(ORR)was 60.6%.20 patients recevied surgical treatment,17 patients achieved R0 resection.The median overall survival(mOS)of all 33 patients was(18.6±4.5)months.The mOS of patients who underwent surgical treatment was(25.7±10.99)months,which in patients without surgical treatment was(11.2±2.5)months(P=0.004).The mOS of stageⅢb/c patients Was(18.9±10.99)months,and of stage IV patients was(11.3±0.35)months(P=0.568).Univariate analysis showed that preoperative chemotherapy cycle≥4 weeks had a better prognosis than patients with less than 4 cycles(P=0.003),TRG score 1/2 patients had a better prognosis(P=0.001),and positive lymph nodes≥7 was risk factor.Multivariate analysis showed that positive lymph nodes≥7 was the only independent prognostic factor(P=0.013).Conclusion For patients with stageⅢb/c or IV inoperable advanced gastric cancer,surgical resection after conversion therapy can improve patient survival,adequate preoperative chemotherapy can improve the prognosis of patients with at least 4 cycles of chemotherapy.