晚期胃癌二线化疗的预后因素分析  

Prognostic factors of patients with advanced gastric cancer treated with second-line chemotherapy

作　　者：赵荣荣[1,2] 刘波[1] 韩淑梅[1] 张国栋[1] 牛作兴[1] 

机构地区：[1]山东省肿瘤医院内四病区,山东济南250117 [2]济南大学.山东省医学科学院医学与生命科学学院,山东济南250200

出　　处：《中华肿瘤防治杂志》2013年第14期1106-1109,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨晚期胃癌患者二线化疗的预后因素,筛选二线化疗的最佳人群。方法:回顾性分析256例接受二线化疗的晚期胃癌患者,采用Kaplan-Meier法计算生存率,Log-rank检验比较各亚组生存率,采用Cox比例分析模型作临床病理特征对生存率影响的单因素和多因素分析。结果:二线化疗的客观有效率18.0%,中位至进展时间(TTP)3.0个月,中位生存期(OS)8.1个月,1年生存率24.4%。多因素分析发现,分化程度(RR=1.33;95%CI:1.02～1.74;P=0.04)、一线化疗的TTP(RR=2.12;95%CI:1.59～2.83;P=0.00)、二线化疗前PS评分(RR=5.42;95%CI:3.65～8.05;P=0.00)和血红蛋白(RR=3.56;95%CI:2.49～5.09;P=0.00)是晚期胃癌二线化疗的独立预后因素。根据患者含预后不良因素的个数,分为低危(0)、中危(1～2)和高危(3～4)3组,3组的中位生存期分别为10.2、6.4和3.3个月,1年生存率分别为39.2%和8.5%,0,P=0.00。结论:影响晚期胃癌二线化疗的独立预后因素包括分化程度、二线化疗前PS评分、血红蛋白和一线化疗的TTP,可作为筛选晚期胃癌二线化疗适宜人群的有效指标。OBJECTIVE：To evaluate the prognostic factors in patients treated for advanced gastric cancer with sec ond-line chemotherapy and to identify the optimal indications for second-line chemotherapy. METHODS： A total of 256 patients with advanced gastric cancer treated with second-line chemotherapy were analyzed. Survival data were analysed u- sing the Kaplan-Meier product-limit method. Comparison of survival curves were performed using log-rank test. Univariate and multivariate analysis was carried out using Cox proportional hazards regression modelling. RESULTS： Overall response rate was 18.0 to second-line chemotherapy. The median time to progression and median overall survival（OS） calculated from the start of second-line chemotherapy, were 3.0 months and 8. 1 months. 1-year OS rate was 24.4 %. Multivariate analysis showed that poor differentiation（relative risk（RR）, 1.33% 95 % CI, 1.02-1.74% P = 0. 04）, performance status 2 （RR, 5.42; 95 CI, 3.65--8. 053 P=0. 00） ,hemoglobin level 〈100 g/L（RR,3.56; 95%CI,2.49--5.09P=0.00） at initiation of second-line chemotherapy, and time to progression（TTP） less than 5 months on first-line chemotherapy（RR, 2.12; 95 CI 1.59--2.83P = 0. 00） were identified as independent negative prognostic factors. According to the number of negative prognostic factors divide the patients into three risk groups：low-risk group（0）, intermediate-risk group（ 1- 2） and high-risk group（3- 4）. The median survival for low-risk,intermediate-risk, and low-risk groups were 10. 2 months, 6.4 months, 3.3 months respectively, whereas the 1-year OS rates were 39.2 %, 8. 5 % 0, respectively（ P = 0. 00）. CONCLUSION.. differentiation degree, time to progression on first-line chemotherapy,performance status and hemoglobin level at initiation of second-line chemotherapy were identified as independent prognostic factors which,may help to select patients with advanced gastric cancer who could derive more benefit from second-line chemotherapy.

关 键 词：晚期胃癌 二线化疗 预后 多因素分析 

分 类 号：R735.2[医药卫生—肿瘤]