Gastrenterology Unit, "Laikon" University General Hospital, University of Athens, Athens, Greece.
Eur J Surg Oncol. 2011 Apr;37(4):312-8. doi: 10.1016/j.ejso.2011.01.019.
Most patients with gastric cancer present with locally advanced or metastatic disease and usually receive palliative therapy. We sought to identify factors influencing overall survival in patients with stage IV gastric cancer receiving palliative chemotherapy.
The records of 311 patients with histological diagnosis of gastric adenocarcinoma were retrospectively reviewed and 17 clinicopathological and therapeutic parameters were evaluated for their influence on overall survival.
In multivariate analysis nine factors were found to independently influence survival: no previous palliative gastrectomy [Hazard ratio (HR, 12; CI 7.969-18.099)], single agent chemotherapy instead of combination chemotherapy (HR, 1.35; CI 1.068-1.721), histological grade III (HR, 1.39; 95% CI 1.098-1.782), the presence of hepatic (HR, 1.6; 95% CI 1.246-2.073) and abdominal metastasis (HR, 1.33; 95% CI 1.039-1.715), CA 72-4 > 7 U/L (HR, 1.39; 95% CI 1.026-1.887), LDH > 225 U/L (HR, 1.72; 95% CI 1.336-2.236], need for blood transfusions (HR, 1.58; 95% CI 1.213-2.082), and weight loss > 5% (HR, 1.96; 95% CI 1.352-2.853) at the time of initial diagnosis. Patients were stratified as low (0-2 factors), intermediate (3-6 factors) and high (7-9 factors) risk and the median survival was 76, 40 and 11 weeks, respectively.
Nine clinical and laboratory factors that adversely affect survival in patients with stage IV gastric cancer who receive chemotherapy were identified. Their concurrent presence seems to have an additive effect as patients with seven to nine factors have the worse prognosis. Palliative gastrectomy and combination chemotherapy appear to be associated with improved survival.
大多数胃癌患者表现为局部晚期或转移性疾病，通常接受姑息性治疗。我们试图确定接受姑息化疗的 IV 期胃癌患者的总生存的影响因素。
回顾性分析 311 例组织学诊断为胃腺癌患者的记录，评估 17 项临床病理和治疗参数对总生存的影响。
多因素分析发现 9 个因素独立影响生存：无既往姑息性胃切除术[风险比（HR），12；95%可信区间（CI）7.969-18.099]、单一药物化疗而非联合化疗（HR，1.35；95%CI 1.068-1.721）、组织学分级 III（HR，1.39；95%CI 1.098-1.782）、肝转移（HR，1.6；95%CI 1.246-2.073）和腹部转移（HR，1.33；95%CI 1.039-1.715）、CA72-4>7U/L（HR，1.39；95%CI 1.026-1.887）、LDH>225U/L（HR，1.72；95%CI 1.336-2.236）、需要输血（HR，1.58；95%CI 1.213-2.082）和初始诊断时体重减轻>5%（HR，1.96；95%CI 1.352-2.853）。患者被分为低危（0-2 个因素）、中危（3-6 个因素）和高危（7-9 个因素），中位生存期分别为 76、40 和 11 周。
确定了影响接受化疗的 IV 期胃癌患者生存的 9 个临床和实验室因素。这些因素的同时存在似乎具有累加效应，因为具有 7 至 9 个因素的患者预后最差。姑息性胃切除术和联合化疗似乎与生存改善相关。
