胃癌恶性腹水患者的临床特征及预后影响因素分析  

Analysis on the clinical characteristics and prognostic factors of gastric cancer with malignant ascitespatients

作　　者：白杰[1] 郑琪[1] 廖子君[1] 张彦兵[1] 马婕群 常琳涵 李倩[1] Bai Jie;Zheng Qi;Liao Zijun;Zhang Yanbing;Ma Jiequn;Chang Linhan;Li Qian(Department of Medical Oncology,Affiliated Shaanxi Provincial Tumor Hospital,College of Medicine,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学医学院附属陕西省肿瘤医院肿瘤内科,西安710061

出　　处：《中国肿瘤临床与康复》2023年第7期424-431,共8页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：陕西省卫生计生科研基金(2016D050)。

摘　　要：目的研究胃癌恶性腹水患者的临床特征及其预后影响因素.方法回顾性分析陕西省肿瘤医院2014年1月1日至2019年12月31日收治的124例胃癌恶性腹水患者的临床资料,其中男88例(71.0%),女36例(29.0%);<65岁75例(60.5%),≥65岁49例(39.5%).通过Log rank检验和多因素Cox回归分析,确定影响总生存时间(OS)的独立预后因素,根据预后因素构建预测胃癌恶性腹水患者预后的列线图模型;使用一致性指数(C-index)、受试者工作特征曲线的曲线下面积(AUC)、校准曲线和决策曲线分析法(DCA)对预测模型的性能进行验证.基于患者个体化列线图的总得分,构建胃癌恶性腹水患者的风险分层,分析患者临床特征对预后的影响.结果124例胃癌恶性腹水患者的中位OS为5.4个月,3、6和12个月生存率分别为72.6%、42.7%和15.3%.单因素分析结果显示,美国东部肿瘤协作组(ECOG)评分、胃癌手术史、是否以腹水起病、腹水颜色、肿瘤分化程度、其他器官转移数目、治疗方式以及血清白蛋白(ALB)、总胆红素(TBIL)和乳酸脱氢酶(LDH)水平与患者的中位OS有关(均P<0.05).多因素Cox回归分析结果显示,ECOG评分、是否以腹水起病、其他器官转移数目、血清ALB和TBIL水平以及治疗方式为影响胃癌恶性腹水患者OS的独立因素(均P<0.05).根据多因素分析结果构建预后预测模型的C-index为0.773,预测3、6和12个月生存率的AUC分别为0.864、0.873和0.802.校准曲线显示,预测模型有较高的拟合度.DCA结果显示,预测模型在不同时间截点的阈值概率中均表现出较大的正净收益.根据列线图产生的每例患者的总得分进行OS风险分层,低、中、高风险组患者的中位OS分别为7.5、4.0和1.9个月,各组间生存差异有统计学意义(P<0.001).结论胃癌恶性腹水患者的ECOG评分、是否以腹水起病、其他器官转移数目、血清ALB水平、血清TBIL水平以及治疗方式是影响患者预后的独立因�Objectives To study the clinical characteristics and prognostic factors of gastric cancer with malignant ascites(GC-MA)patients.Methods The clinical data of 124 GCMA patients in Shaanxi Tumor Hospital from January 1,2014 to December 31,2019 were collected.Of the 124 patients,88(71.0%)are male and 36(29.0%)are female.There are 75 patients<65 years old and 49 patients≥65 years old.The independent prognostic factors of overall survival(OS)were determined by the univariate log-rank test and multivariate Cox regression analysis,and a nomogram model on predicting OS of GC-MA patients was constructed based on these independent prognostic factors.Concordance index(C-index),area under the curve(AUC)of receiver operating characteristic curve,calibration curve and decision curve analysis(DCA)were used to evaluate the performance of this prognostic model.Risk stratification of GCMA patients was constructed based on the total score of patient's individualized nomogram.Results The median OS of 124 GC-MA patients was 5.4 months,the 3-,6-,12-month overall survival rate was 72.6%,42.7%,and 15.3%,respectively.Univariate analysis showed that the Eastern Cooperative Oncology Group(ECOG)score,the surgery history,the initial presentation with ascites,the colors of ascites,the grade of tumor differentiation,the number of metastases in other organs,the treatment measures as well as the serum levels of albumin(ALB),total bilirubin(TBIL)and lactate dehydrogenase(LDH)were related with OS in GC-MA patients(P<0.05).Multivariate Cox regression analysis showed that the ECOG score,the initial presentation with ascites,the number of metastases in other organs,the serum levels of ALB and TBIL as well as the treatment measures were independent prognostic factors of OS in GC-MA patients(P<0.05).Based on results of multivariate Cox regression,a prognostic model of OS was constructed.The C-index of this model was 0.73,the AUCs in predicting 3-,6-,and 12-month overall survival rate was 0.864,0.873,and 0.802,respectively.Furthermore,the calibration c

关 键 词：胃肿瘤 恶性腹水 预后 

分 类 号：R735.2[医药卫生—肿瘤]