胃癌肝转移患者的治疗方式和预后影响因素分析  

Treatment methods for patients with gastric cancer liver metastasis and prognostic factors analysis

作　　者：蒋子健 薛侃[1] 陕飞[2] 张燕[1] 戴红梅 吴舟桥[1] 李浙民 王胤奎[1] 李子禹[1] 季加孚[2] Jiang Zijian;Xue Kan;Shan Fei;Zhang Yan;Dai Hongmei;Wu Zhouqiao;Li Zhemin;Wang Yinkui;Li Ziyu;Ji Jiafu(Gastrointestinal Cancer Center WardⅠ,Peking University Cancer Hospital,Beijing Institute for Cancer Research,Key Laboratory of Carcinogenesis and Translational Research of Ministry of Education,Beijing 100142,China;Peking University Cancer Hospital,Beijing Institute for Cancer Research,National Key Laboratory of Integrated Prevention and Treatment of Digestive System Tumor,Key Laboratory of Carcinogenesis and Translational Research of Ministry of Education,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠中心一病区,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所,消化系肿瘤整合防治全国重点实验室,恶性肿瘤转化研究北京市重点实验室,北京100142

出　　处：《中华消化外科杂志》2024年第12期1511-1517,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(92259302);北京大学医学类世界领先学科或学科集群发展基金(BMU2022XKQ004)。

摘　　要：目的探讨胃癌肝转移患者的治疗方式和预后影响因素。方法采用回顾性队列研究方法。收集2010年1月1日至2020年1月1日北京大学肿瘤医院收治的282例胃癌肝转移患者的临床病理资料;男237例,女45例;年龄为(66±10)岁。282例患者中,肝寡转移94例,肝多发转移188例。根据患者的个体情况选择手术治疗、全身或局部治疗。观察指标:(1)胃癌肝转移患者的治疗方式。(2)胃癌肝转移患者随访和预后情况。(3)影响胃癌肝转移患者预后的因素分析。计数资料组间比较采用χ^(2)检验。等级资料比较采用非参数秩和检验。单因素分析采用log‑rank检验。采用Cox比例风险回归模型进行多因素分析,通过逐步回归前进法筛选相关变量。采用Kaplan‑Meier法计算生存率和绘制生存曲线,采用log‑rank检验进行生存分析。结果(1)胃癌肝转移患者的治疗方式。94例胃癌肝寡转移和188例胃癌肝多发转移患者手术治疗方式、肝动脉灌注化疗、射频消融术比较,差异均有统计学意义(χ^(2)=21.97、6.04、8.78,P<0.05)。(2)胃癌肝转移患者随访和预后情况。282例胃癌肝转移患者均完成随访,随访时间为781(3~4100)d,1、3、5年总生存率分别为61.0%、19.5%、11.0%。胃癌肝寡转移患者总生存时间为659(549~769)d,1、3、5年总生存率分别为69.1%、30.9%、18.1%;胃癌肝多发转移患者总生存时间为519(451~587)d,1、3、5年总生存率分别为56.9%、13.8%、7.4%;两者生存情况比较,差异有统计学意义(χ^(2)=8.45,P<0.05)。(3)影响胃癌肝转移患者预后的因素分析。多因素分析结果显示:东部肿瘤协作组评分、手术治疗方式、化疗、靶向治疗、射频消融术均是胃癌肝转移患者预后的独立影响因素(优势比=3.68、0.82、0.58、0.64、0.52,95%可信区间为1.85~7.33、0.67~1.00、0.40~0.86、0.44~0.92、0.30~0.90,P<0.05)。结论胃癌肝寡转移与肝多发转移患者的治疗方式不同,前者�Objective To investigate the treatment methods for patients with gastric cancer liver metastasis and prognostic factors.Methods The retrospective cohort study was conducted.The clinicopathological data of 282 patients with gastric cancer liver metastasis who were admitted to Peking University Cancer Hospital from January 1st,2010 to January 1st,2020 were collected.There were 237 males and 45 females,aged(66±10)years.Of the 282 patients,there were 94 cases with liver oligometastasis and 188 cases with liver multiple metastases.Patients underwent surgical treatment,systemic treatment or local treatment based on the individual condition.Observation indicators:(1)treatment methods for patients with gastric cancer liver metastasis;(2)follow-up and prognosis of patients with gastric cancer liver metastasis;(3)prognostic factors analysis in patients with gastric cancer liver metastasis.Comparison of count data between groups was conducted using the chi‐square test.Comparison of ordinal data was conducted using the nonparameter rank sum test.The univariate analysis was conducted using the log-rank test.The multivariate analysis was conducted using the Cox proportional hazards regression model,and relevant variables were screened through stepwise regression forward method.The Kaplan‐Meier method was used to calculate survival rate and plot survival curve,and the log‐rank test was used for survival analysis.Results(1)Treatment methods for patients with gastric cancer liver metastasis.There were significant differences in surgical treatment methods,hepatic artery infusion chemotherapy,and radiofrequency ablation between the 94 patients with gastric cancer liver oligometastasis and the 188 patients with gastric cancer liver multiple metastases(χ^(2)=21.97,6.04,8.78,P<0.05).(2)Follow-up and prognosis of patients with gastric cancer liver metastasis.All 282 patients with gastric cancer liver metastasis were followed up for 781(range,3−4100)days,and the 1‐,3‐,5‐year overall survival rates were 61.0%,19.5%,11.0%,

关 键 词：胃肿瘤 肝转移 寡转移 手术治疗 射频消融术 全身治疗 疗效 危险因素 

分 类 号：R735.2[医药卫生—肿瘤] R735.7[医药卫生—临床医学]