国际肿瘤学杂志

国际肿瘤学杂志 ›› 2020, Vol. 47 ›› Issue (3): 151-156.doi: 10.3760/cma.j.issn.1673-422X.2020.03.005

• 论著 • 上一篇    下一篇

晚期胃癌姑息放疗的疗效观察及预后分析

朱莹, 周丹阳, 于丹丹(), 张涛   

  1. 华中科技大学同济医学院附属协和医院肿瘤中心,武汉 430022
  • 收稿日期:2019-07-31 修回日期:2019-12-20 出版日期:2020-03-08 发布日期:2020-05-27
  • 通讯作者: 于丹丹 E-mail:yudandan@hust.edu.cn
  • 基金资助:
    国家重点研发计划(2018YFC1313300);国家自然科学基金(81872429);国家自然科学基金(81874061);国家自然科学基金(81874061);国家自然科学基金(81874061)

Efficacy and prognosis of palliative radiotherapy for advanced gastric cancer

Zhu Ying, Zhou Danyang, Yu Dandan(), Zhang Tao   

  1. Cancer Center, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2019-07-31 Revised:2019-12-20 Online:2020-03-08 Published:2020-05-27
  • Contact: Yu Dandan E-mail:yudandan@hust.edu.cn
  • Supported by:
    National Key Research and Development Plan(2018YFC1313300);National Natural Science Foundation of China(81872429);National Natural Science Foundation of China(81874061);National Natural Science Foundation of China(81874061);National Natural Science Foundation of China(81874061)

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摘要：

目的 探讨姑息放疗在晚期胃癌患者中的临床疗效及预后影响因素。方法 收集2013年1月至2018年12月于华中科技大学同济医学院附属协和医院肿瘤中心诊治的390例晚期胃癌患者的临床资料,根据治疗方法分为联合放化疗组(n=95)和单纯化疗组(n=295)。采用门诊复查、电话及短信等方式进行定期随访。回顾性分析姑息放疗在晚期胃癌患者中的临床疗效及预后影响因素。结果 联合放化疗组中位生存时间28.07个月、6个月生存率89.0%、1年生存率68.0%、2年生存率51.0%,单纯化疗组中位生存时间11.27个月、6个月生存率69.0%、1年生存率40.0%、2年生存率15.0%,联合放化疗组生存率优于单纯化疗组(χ 2=27.400,P<0.001)。289例初诊晚期胃癌患者中,联合放化疗组中位生存时间28.07个月,显著长于单纯化疗组的11.47个月(χ 2=23.681,P<0.001)。101例术后复发胃癌患者中,联合放化疗组中位生存时间16.37个月,显著长于单纯化疗组的10.53个月(χ 2=5.164,P=0.023)。放疗前化疗方案(χ 2=7.019,P=0.030)、放疗前疾病控制情况(χ 2=4.689,P=0.030)、放疗前美国东部肿瘤协作组(ECOG)评分(χ 2=8.529,P=0.014)、放疗部位(χ 2=4.763,P=0.029)是影响行姑息放疗晚期胃癌患者预后的相关因素。多因素分析显示,放疗前ECOG评分(HR=2.252,95%CI为1.288~3.935,P=0.004)、放疗前疾病控制情况(HR=2.604,95%CI为1.183~5.730,P=0.017)是影响患者生存的独立预后因素。结论 对于初诊晚期胃癌患者及术后复发胃癌患者,联合放化疗疗效显著优于单纯化疗。放疗前化疗方案、放疗前疾病控制情况、放疗前ECOG评分、放疗部位对行姑息放疗晚期胃癌患者的预后产生影响,其中放疗前ECOG评分、放疗前疾病控制情况是影响患者生存的独立预后因素。

关键词: 胃肿瘤, 放射疗法, 姑息疗法, 预后

Abstract:

Objective To investigate the efficacy and prognostic factors of palliative radiotherapy for advanced gastric cancer. Methods From January 2013 to December 2018, the clinical data of 390 patients with advanced gastric cancer in the Cancer Center of Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected. Patients were divided into two groups—combined chemoradiotherapy group (n=95) and chemotherapy alone group (n=295) according to the treatment method. Patients were followed up by outpatient reviews, phone calls or text messages at regular intervals. The clinical efficacy and prognostic factors of palliative radiotherapy in patients with advanced gastric cancer were retrospectively analyzed. Results The median survival time and the 6-month, 1-year, 2-year survival rates of combined chemoradiotherapy group and chemotherapy alone group were respectively 28.07 months versus 11.27 months, 89.0% versus 69.0%, 68.0% versus 40.0%, 51.0% versus 15.0%. The survival rate of the combined chemoradiotherapy group was significantly higher than that of the chemotherapy alone group (χ 2=27.400, P<0.001). The median survival time of the combined chemoradiotherapy group was significantly longer than that of chemotherapy alone group in both 289 first-time diagnosed patients (χ 2=23.681, P<0.001) and 101 recurrent gastric cancer patients (χ 2=5.164, P=0.023), with median survival time being 28.07 months versus 11.47 months and 16.37 months versus 10.53 months respectively. Chemotherapy regimen before radiotherapy (χ 2=7.019, P=0.030), disease control before radiotherapy (χ 2=4.689, P=0.030), Eastern Cooperative Oncology Group (ECOG) score before radiotherapy (χ 2=8.529, P=0.014) and radiotherapy area (χ 2=4.763, P=0.029) were factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. Multivariate analysis showed that ECOG score (HR=2.252, 95%CI: 1.288-3.935, P=0.004) and disease control before radiotherapy (HR=2.604, 95%CI: 1.183-5.730, P=0.017) were independent prognostic factors. Conclusion The efficacy of combined chemoradio-therapy is significantly better than chemotherapy alone in both first-time diagnosed and recurrent advanced gastric cancer. Chemotherapy regimen before radiotherapy, disease control before radiotherapy, ECOG score before radiotherapy and radiotherapy area are factors influencing the prognosis of patients with advanced gastric cancer undergoing palliative radiotherapy. ECOG score and disease control before radiotherapy are independent prognostic factors.

Key words: Stomach neoplasms, Radiotherapy, Palliative care, Prognosis