对产甲胎蛋白胃癌患者预后的COX多因素回归分析及中医治疗  

COX multivariate analysis and traditional Chinese medicine treatment of prognostic factors in patients with alpha-fetoprotein-producing gastric carcinoma

作　　者：张彤[1] 孙颖颖 轩艳红 张洪亮 何文婷 ZHANG Tong;SUN Yingying;XUAN Yanhong;ZHANG Hongliang;HE Wenting(Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing100091,China;Emergency General Hospital,Beijing 100028,China;Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region,Urumuchi 830001,China)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]应急总医院 [3]新疆维吾尔自治区中医医院

出　　处：《北京中医药大学学报》2022年第12期1288-1294,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：吴阶平医学基金会临床研究项目(No.320.6750.19076)。

摘　　要：目的通过对产甲胎蛋白胃癌(AFPGC)患者的临床特征、中药使用和生存情况进行分析,以期提高中医临床医生对AFPGC的认识。方法回顾性收集2012年1月—2018年12月经病理诊断并且联合中医药治疗的胃癌患者病例,经纳入、排除标准筛选后,纳入AFPGC患者46例与普通胃癌患者363例。通过对比临床及生存特征,分析不同甲胎蛋白(AFP)水平患者的生存差异,COX多因素回归分析判断AFPGC患者预后因素,并对中医治则及处方进行分析。结果AFPGC占全部胃癌的4.1%。维吾尔族与哈萨克族患AFPGC的比例高于汉族(P<0.001),AFPGC的肿瘤侵犯程度更深(P=0.032),淋巴转移和远处转移的患者比例更高(P=0.016,P<0.001),AFPGC患者接受化学药物治疗(化疗)和手术的机会低于普通胃癌患者(P=0.018,P=0.001),肝转移、腹膜转移的比例明显高于普通胃癌(均P<0.001);AFPGC患者中位总生存时间(mOS)为11(95%CI:7~14)个月,明显少于普通胃癌的33(95%CI:26~45)个月,AFPGC患者较普通胃癌患者死亡风险升高3倍(HR=3.00,P<0.001)。AFPGC患者第1、3、5年的生存率分别为46.7%、11.1%、2.3%,与普通胃癌患者比较差异有统计学意义(P<0.001)。按AFP水平分为阴性(<20μg/L)、低(20~300μg/L)、高(>300μg/L)3个亚组,各亚组患者mOS分别是33.0、14.0、6.5个月,差异有统计学意义(P<0.001)。根治性手术、AFP水平是AFPGC患者独立预后因素,根治性手术可降低AFPGC患者61.2%的死亡风险,AFP高水平患者是AFP低水平患者死亡风险的1.98倍,差异均有统计学意义(P=0.029,P=0.048)。中医治则以健脾益气、和胃化痰法最为常用,患者首诊处方中抗肿瘤中药以扶正补虚类为主。结论AFPGC具有独特的临床特征,生物学行为差,易发生肝、淋巴结、腹膜转移,分期偏晚,能接受手术、化疗的机会低于普通胃癌,生存明显差于普通胃癌,且与AFP水平显著负相关。根治性手术是唯一明确可改善AFPGC预后的方法。Objective We analyzed the clinical characteristics,survival of alpha-fetoprotein-producing gastric carcinoma(AFPGC)patients,and traditional Chinese medicine(TCM)treatment on them to improve TCM clinicians′recognition of AFPGC.Methods We retrospectively collected the clinical and survival characteristics of patients with gastric cancer who were pathologically diagnosed and treated with TCM from January 2012 to December 2018,including 46 patients with AFPGC and 363 patients with common gastric cancer,according to the eligibility criteria.To compare and analyze the survival of patients with different alpha-fetoprotein(AFP)levels,we performed COX multivariate analysis of the prognostic factors of AFPGC patients and an analysis of TCM treatment principles and prescriptions.Results AFPGC patients accounted for 4.1%of all gastric cancers patients.Compared with common gastric cancer,the proportion of AFPGC was found to be higher in Uyghur and Kazakh patients than in Han patients(P<0.001).AFPGC patients also showed marked invasion depths(P=0.032),higher ratio of lymphatic metastasis or distant metastasis(P=0.016,P<0.001),and had lower chances of receiving chemotherapy and surgery(P=0.018,P=0.001,respectively).The proportion of liver and peritoneal metastases was also higher in AFPGC patients(P<0.001,each).The medium overall survival(mOS)of AFPGC patients was 11(95%CI:7-14)months,while that for common gastric cancer was 33(95%CI:26-45)months.AFPGC patients had a three-fold increased hazard ratio for death in common gastric cancer patients(HR=3.00,P<0.001).The survival rates of AFPGC patients at 1,3,and 5 years were 46.7%,11.1%,and 2.3%,lower,respectively,than that of the common gastric cancer patients(P<0.001).We conducted subgroup analysis according to the level of AFP,<20μg/L,20-300μg/L,and>300μg/L.The mOS of the three groups of patients was 33.0,14.0,and 6.5 months,and the difference was significant(P<0.001).Radical surgery and AFP level were independent prognostic factors in AFPGC patients,and radical surgery coul

关 键 词：产甲胎蛋白胃癌 生存曲线 COX多因素回归分析 中医药治疗 

分 类 号：R273[医药卫生—中西医结合]