原发灶姑息放疗对未接受原发灶手术的局部晚期或远处转移性胃癌患者远期生存影响的多中心、回顾性研究  

Multi-center,retrospective study of primary lesion palliative radiotherapy on longterm survival in patients of locally advanced or distal metastatic gastric cancer without primary lesion surgically

作　　者：华丽[1] 陈绍俊[1] 陈海辉[1] 梁世雄[2] HUA Li;CHEN Shaojun;CHEN Haihui;LIANG Shixiong(Department of Oncology,Liuzhou Workers Hospital,Liuzhou 545005,Guangxi,China;Department of Radiotherapy,Cancer Hospital Affiliated to Guangxi Medical University,Nanning 530022,Guangxi,China)

机构地区：[1]柳州市工人医院肿瘤科,广西柳州545005 [2]广西医科大学附属肿瘤医院放疗科,南宁5300220

出　　处：《癌症进展》2021年第8期823-827,共5页Oncology Progress

基　　金：广西壮族自治区卫健委自筹课题(Z20180505)。

摘　　要：目的探讨原发灶姑息放疗对未接受原发灶手术的局部晚期或远处转移性胃癌患者远期生存的影响。方法选取126例未经原发灶手术治疗的局部晚期或转移性胃癌患者,所有患者均接受三维调强放射治疗,放疗范围只包括可见的大体肿瘤,不做淋巴引流区的预防照射。总剂量为45.0~50.4 Gy,单次剂量为1.8~2.0 Gy,并同时接受至少2个周期以上含铂的双药化疗。通过Kaplan-Meier法观察患者的生存情况,采用Cox回归模型分析影响OS的相关因素。结果中位随访35个月,中位总生存期(OS)18个月,中位无进展生存期(PFS)10个月,1、2、3年总生存率分别为57.8%、37.3%、20.6%。单因素分析结果显示,年龄、N分期、M分期、对初始化疗反应情况、体力状况(PS)评分、转移病灶个数、转移类型均可能是未接受原发灶手术的局部晚期或远处转移性胃癌患者OS的影响因素。多因素分析结果显示,N分期、M分期、对初始化疗反应情况、转移类型均是未接受原发灶手术的局部晚期或远处转移性胃癌患者OS的影响因素(P﹤0.05)。分层分析显示,在转移性胃癌中,寡转移患者的OS较多发弥漫性转移的患者明显延长(HR=15.028,95%CI:7.000~32.260,P=0.000)。结论对初始化疗反应良好且为寡转移的胃癌患者,通过原发灶姑息放疗,可获得生存获益。Objective To investigate the effect of primary lesion palliative radiotherapy on long-term survival in patients of locally advanced or distal metastatic gastric cancer without primary lesion surgically.Method A total of 126 patients of locally advanced or distal metastatic gastric cancer without primary lesion surgically were selected.All patients received three-dimensional intensity-modulated radiation therapy.The radiation area only included the visible gross tumor without preventive radiation of lymph drainage area.The total dose was 45.0-50.4 Gy and the single dose was 1.8-2.0 Gy.At the same time,at least two cycles of dual drug chemotherapy containing platinum should be received.Kaplan-Meier method was used to observe the survival of patients,and Cox regression model was used to analyze the prognostic factors affecting survival.Result The median follow-up period was 35 months.The median overall survival(OS)was 18 months.The median progression free survival(PFS)was 10 months.The overall survival rates of 1-year,2-year,and 3-year were 57.8%,37.3%,and 20.6%,respectively.Univariate analysis showed that age,N stage,M stage,initial response to chemotherapy,physical status(PS)score,number of metastatic lesions and type of metastasis may be the influencing factors of OS in patients of locally advanced or distal metastatic gastric cancer without primary lesion surgically.Multivariate analysis showed that N stage,M stage,initial response to chemotherapy and type of metastasis were the influencing factors of OS in patients of locally advanced or distal metastatic gastric cancer without primary lesion surgically(P<0.05).Stratified analysis showed that the survival of patients with oligo metastasis was significantly longer than that of patients with diffuse metastasis(HR=15.028,95%CI:7.000-32.260,P=0.000).Conclusion Palliative radiotherapy has possible survival benefit foroligometastaticgastric cancer patients who hasgood response to initial chemotherapy.

关 键 词：胃癌 转移 姑息放疗 化疗 寡转移 

分 类 号：R735.2[医药卫生—肿瘤]