胃癌异时性肝转移的治疗及预后因素分析  

Treatment and prognostic factor analysis of metachronous liver metastases from gastric cancer

作　　者：王维佳[1] 张汝鹏[1] 张辉[1] 邓靖宇[1] 王学军[1] 薛强[1] 梁寒[1] 

机构地区：[1]天津医科大学肿瘤医院胃部肿瘤科、国家肿瘤临床医学研究中心、天津市肿瘤防治重点实验室,300060

出　　处：《中华消化外科杂志》2014年第3期185-189,共5页Chinese Journal of Digestive Surgery

基　　金：国家重点基础研究发展计划（973计划）项目（2010CB529301）

摘　　要：目的探讨胃癌异时性肝转移的治疗方式及影响预后的相关因素。方法回顾性分析1996年1月至2008年12月天津医科大学肿瘤医院收治的102例胃癌异时性肝转移患者的临床病理资料。其中行单纯化疗64例，化疗联合TACE19例，化疗联合肝转移癌切除19例。患者在术后3年内，每3个月来院随访复查1次，3年后每6个月1次，5年后每年1次。复查内容包括体格检查、实验室检查和影像学检查等。随访时间截至2013年10月。采用Kaplan—Meier法绘制生存曲线，Log—rank法进行显著性检验，COX模型进行预后因素分析。结果102例中行单纯化疗的64例患者，部分缓解15例、稳定22例、进展27例；化疗联合TACE的19例患者，部分缓解6例、稳定9例、进展4例；化疗联合肝转移癌切除的19例患者，术后发生切口感染1例，围手术期无死亡。胃癌复发死亡者16例，其中局部复发10例、多灶复发6例。102例患者中有8例失访，随访时间9～149个月。总体中位生存时间为8个月（2～70个月），1、3、5年生存率分别为40．2％、17．7％、6．8％。其中64例单纯化疗者中位生存时间为5个月（2—37个月），1、3、5年生存率分别为15．6％、3．5％、0；19例行化疗联合TACE者中位生存时间为6个月（3～36个月），1、3、5年生存率分别为26．1％、6．5％、0；19例行化疗联合肝转移癌切除者中位生存时间为15个月（5～70个月），1、3、5年生存率分别为63．2％、31．6％、16．8％。联合肝转移癌切除者与单纯化疗和联合TACE者累积生存率比较，差异有统计学意义（X2=23．900，P〈0．05）。单因素分析结果显示：原发癌直径、分化程度、是否存在肝外转移、肝转移癌类型、肝转移癌数目和治疗方式与胃癌异时性肝转移的预后相关（，=6．307，7．908，4．375，45．188，18．234，23．900，P〈0．05）。多因素分析结果显示：肝转移�Objective To explore the treatment methods and prognostic factors of metachronous liver metastases from gastric cancer. Methods The elinicopathological data of 102 patients with metachronous liver metastases from gastric cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 1996 to December 2008 were retrospectively analyzed. Sixty-four patients received systemic chemotherapy, 19 received systemic chemotherapy ＋ transcatheter arterial chemoembolization （ TACE ）, and 19 received systemic chemotherapy ＋ radical resection of the metachronous liver cancer. Patients were re-examined every 3 months within the first 3 years after operation, and every 6 months after postoperative year 3, and every 1 year after postoperative year 5. Physical examination, laboratory test and imaging examination were done during the follow-up. The follow- up was ended in October 2013. The cumulative survival rates of the patients were calculated and compared using the Kaplan-Meier method and the Log-rank test, respectively. The prognostic factors were analyzed using the COX regression model. Results The disease was alleviated in 15 patients, progressed in 27 patients, and the condition was stable in 22 patients after systemic chemotherapy. The disease was alleviated in 6 patients, progressed in 4 patients and the condition was stable in 9 patients after systemic chemotherapy ＋ TACE. Of the 19 patients receivedsystemic chemotherapy ＋ radical resection of the metachronous liver cancer, 1 was complicated with incisional infec- tion, and no patient died perioperatively. Sixteen patients died of gastric cancer recurrence including 10 patients with local recurrence and 6 patients with multiple lesions recurrence. Eight patients missed the follow-up, the others were followed up for 9-149 months. The overall median survival time was 8 months （range, 2-70 months）, and the 1-, 3-, 5-year survival rates were dO. 2%, 17.7% and 6.8%, respectively. The median survival time of the 64 patients who receiv

关 键 词：胃肿瘤 异时性肝转移 治疗 预后因素 

分 类 号：R735.2[医药卫生—肿瘤]