Ⅲ期老年胃癌患者根治术后单药与多药辅助化疗的疗效分析  

Efficacy analysis of single-agent versus multi-agent adjuvant chemotherapy after radical gastrec-tomy for elderly patients with stageⅢgastric cancer

作　　者：王子辰 王扬扬 王书昌[1] 王超杰[1] 赵恩昊[1] 曹晖[1] Wang Zichen;Wang Yangyang;Wang Shuchang;Wang Chaojie;Zhao Enhao;Cao Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中华消化外科杂志》2023年第10期1212-1218,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82103348);上海市科技创新行动计划自然科学基金(23ZR1439400);上海交通大学“交大之星”计划医工交叉研究基金(YG2023QNA10)。

摘　　要：目的比较Ⅲ期老年胃癌患者根治术后单药与多药辅助化疗的疗效。方法采用倾向评分匹配及回顾性队列研究方法。收集2016年1月至2020年12月上海交通大学医学院附属仁济医院收治的456例行D2根治术Ⅲ期老年胃癌患者的临床病理资料;男343例,女113例;年龄为71(65~89)岁。456例患者中,274例术后行单药辅助化疗设为单药化疗组;182例术后行两药或三药辅助化疗设为多药化疗组。观察指标:(1)倾向评分匹配情况及匹配后两组患者一般资料比较。(2)化疗期间不良事件。(3)随访情况。倾向评分匹配按1∶1匹配,卡钳值设置为0.05。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料组间比较采用非参数秩和检验。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-Rank检验进行生存分析。结果(1)倾向评分匹配情况及匹配后两组患者一般资料比较。456例患者中,306例配对成功,单药化疗组和多药化疗组各153例。倾向评分匹配后,消除年龄、年龄校正查尔森合并症指数、病理学TNM分期因素混杂偏倚,具有可比性。(2)化疗期间不良事件。单药化疗组和多药化疗组患者血液学不良事件中性粒细胞减少症分别为6例和16例,两组比较,差异有统计学意义(χ^(2)=4.90,P<0.05)。单药化疗组患者非血液学不良事件食欲减退、恶心分别为77、50例,多药化疗组患者上述指标分别为96、69例,两组比较,差异均有统计学意义(χ^(2)=4.80,4.96,P<0.05)。(3)随访情况。306例患者均获得随访,随访时间为48(8~61)个月。单药化疗组和多药化疗组患者5年总生存率分别为36.08%和38.31%,两组比较,差异无统计学意义(风险比=0.93,95%可信区间为0.70~1.20,P>0.05)。进一步研究结果显示:单药化疗组97例患者与多药化疗组中97例�Objective To compare the efficacy of single-agent versus multi-agent adjuvant chemotherapy after radical gastrectomy for elderly patients with stageⅢgastric cancer.Methods The propensity score matching and retrospective cohort study were conducted.The clinicopatholo-gical data of 456 elderly patients with stageⅢgastric cancer who underwent D2 radical resection in the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2020 were collected.There were 343 males and 113 females,aged 71(range,65‒89)years.Of the 456 patients,274 cases undergoing single-agent adjuvant chemotherapy after surgery were divided into single-agent chemotherapy group,182 cases undergoing double-agent or triple-agent adjuvant chemotherapy after surgery were divided into multi-agent chemotherapy group.Observa-tion indicators:(1)propensity score matching and comparison of general data of patients between the two groups after matching;(2)adverse events during chemotherapy;(3)follow-up.Propensity score matching was done by the 1∶1 ratio,with the caliper value of 0.05.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data between groups was conducted using the non-parameter rank sum test.The Kaplan-Meier method was used to draw survival curves and calculate survival rates,and the Log-Rank test was used for survival analysis.Results(1)Propensity score matching and comparison of general data of patients between the two groups after matching.Of 456 patients,306 cases were successfully matched,including 153 cases in the single-agent chemotherapy group and 153 cases in the multi-agent chemotherapy group.The elimination of age,age-adjusted Charlson comorbidity index,pathological T

关 键 词：胃肿瘤 进展期 辅助化疗 替吉奥 预后 

分 类 号：R735.2[医药卫生—肿瘤]