内镜下缩瘤术治疗老年晚期胃癌的临床疗效  

Efficacy of locally endoscopic cytoreductive surgery in elderly patients with advanced gastric cancer

作　　者：李朝燕[1] 顾剑锋[1] 丁威[1] 席素娟 岳海燕[1] 熊伟民[1] 李明峰[1] 

机构地区：[1]中国人民解放军第455医院消化肿瘤科,上海市200052

出　　处：《世界华人消化杂志》2016年第28期3991-3997,共7页World Chinese Journal of Digestology

基　　金：军区医学科技创新课题基金资助项目;No.15MS025~~

摘　　要：目的回顾性分析106例老年晚期胃癌病例,评价内镜下缩瘤术对老年晚期胃癌预后的影响.方法将收集的老年晚期胃癌病例分为采用内镜下缩瘤术治疗的治疗组和仅接受最佳支持治疗的同期对照组,主要观察指标为有效率和生存期.完成4疗程以上缩瘤术治疗后评估短期疗效及不良反应.采用Cox多因素分析方法 ,在基线均衡的条件下比较两组胃癌病例的生存期,Kaplan-Meier法估算中位生存时间.结果收集中国人民解放军第455医院消化肿瘤科2010-01-01/2015-06-30诊治的老年晚期胃癌患106例,治疗组为51例,对照组为55例,治疗组和对照组的近期有效率分别为76.5%和27.3%(P<0.05).C o x多因素回归分析示:内镜下缩瘤治疗(P=0.000)、肿瘤大小(P=0.000)是影响老年晚期胃癌病例生存期的独立的预后因素,在组间基线均衡的条件下,治疗组(51例)的中位生存期较对照组(55例)延长(12.496 mo vs 8.384 mo,P=0.000),采用内镜下缩瘤治疗的相对危险度:0.430(95%CI:0.274-0.675).治疗组1、2年生存率较对照组明显延长(52.8%vs 29.1%、22.9%vs 2.8%).结论内镜下缩瘤术对晚期胃癌具有较好临床疗效,可延长老年晚期胃癌患者的生存期,使其生存获益.AIM To evaluate the efficacy of locally endoscopic cy to reductive surgery in the treatment of advanced gastric cancer in elderly patients as well as its influence on prognosis.METHODS Elderly patients with advanced gastric cancer were assigned to either a treatment group to receive locally endoscopic cytoreductive surgery or a control group to receive best supportive care.The primary endpoints were response rate（RR） and overall survival（OS）.The efficacy and safety were evaluated after four complete courses of locally endoscopic cytoreductive surgery.Multivariate Coxregression analysis was performed to determine survival trends adjusted for clinical and demographic factors.Kaplan-Meier curves were used to assess the differences in survival time.RESULTS A total of 106 elderly patients treated from January 1,2010 to December 31,2015 were enrolled,including 51 in the treatment group and 55 in the control group.The overall response rates of the two groups were 76.5%and 27.3%,respectively（P 0.05）.Coxregression analysis suggested that endoscopic cytoreductive surgery（P=0.000） and tumor size（P=0.000） were independent prognostic factors.Survival in the control group and treatment group showed a significant increase in median OS from 8.384 mo to 12.496 mo（P=0.000）.The hazard ratio of endoscopic cytoreductive surgery was 0.430（95%CI：0.274-0.675）.Oneand two-year survival rates were 52.8%and22.9%in the treatment group and 29.1%and2.8%in the control group,respectively.CONCLUSION Locally endoscopic cytoreductive surgery has important value in improving the prognosis of elderly patients with advanced gastric cancer,and it shows survival benefit for advanced gastric cancer and prolongs the OS.

关 键 词：晚期胃癌 老年 内镜下缩瘤术 生存期 预后 

分 类 号：R735.2[医药卫生—肿瘤]