Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea.
Endoscopy. 2012 Sep;44(9):807-12. doi: 10.1055/s-0032-1309893. Epub 2012 Jul 2.
Chemotherapy has been suggested to affect the outcome of pyloric stent placement. This study aimed to investigate the association between the response to chemotherapy and pyloric stent outcome.
Data from 113 patients with inoperable gastric cancer who received chemotherapy after pyloric stent placement at the National Cancer Center hospital were analyzed retrospectively. Chemotherapy response was assessed using the Response Evaluation Criteria in Solid Tumors. A Cox proportional hazards model was used to evaluate the effect of chemotherapy response on the complications of stents.
The stent migration rate was 15.9% (18/113) and the re-stenosis rate was 30.1% (34/113). The response rates to chemotherapy were higher in the first-line group than in the salvage chemotherapy group (second-line or more) (44.8% [26/58] vs. 3.6% [2/55], respectively; P < 0.001). The proportion of patients with long time-to-progression (> 8 weeks) was also higher in the first-line than the salvage chemotherapy group (81.0% [47 /58] vs. 61.8% [34 /55], respectively; P = 0.036). Although, the response to chemotherapy was not associated with stent migration or re-stenosis, a long time-to-progression (adjusted hazard ratio [aHR] = 0.29, 95% confidence interval [CI] 0.13-0.67) and first-line chemotherapy (aHR = 0.45, 95%CI 0.22-0.93) were protective factors against re-stenosis in the multivariate analysis. In patients who received first-line chemotherapy, the median duration of patency of covered and uncovered stents was 20 weeks (95%CI 11-29) and 33 weeks (95 %CI 18-48), respectively (P = 0.317).
A long time-to-progression and first-line chemotherapy were significant protective factors against re-stenosis. In chemotherapy-naïve gastric cancer patients with pyloric obstruction, placement of an uncovered stent followed by chemotherapy can be considered to increase stent patency.
化疗被认为会影响幽门支架置入的效果。本研究旨在探讨化疗反应与幽门支架效果之间的关系。
回顾性分析了在国家癌症中心医院接受幽门支架置入后接受化疗的 113 例不可手术的胃癌患者的数据。使用实体瘤反应评估标准评估化疗反应。使用 Cox 比例风险模型评估化疗反应对支架并发症的影响。
支架迁移率为 15.9%（18/113），再狭窄率为 30.1%（34/113）。一线组的化疗反应率高于挽救化疗组（二线或以上）（44.8%[26/58]比 3.6%[2/55]；P<0.001）。一线组的无进展时间较长（>8 周）的患者比例也高于挽救化疗组（81.0%[47/58]比 61.8%[34/55]；P=0.036）。尽管化疗反应与支架迁移或再狭窄无关，但无进展时间较长（调整后的风险比[aHR]=0.29，95%置信区间[CI]0.13-0.67）和一线化疗（aHR=0.45，95%CI 0.22-0.93）是多变量分析中再狭窄的保护因素。在接受一线化疗的患者中，覆盖和未覆盖支架的通畅中位时间分别为 20 周（95%CI 11-29）和 33 周（95%CI 18-48）（P=0.317）。
无进展时间较长和一线化疗是防止再狭窄的显著保护因素。对于化疗初治的幽门梗阻胃癌患者，放置未覆盖支架后进行化疗可增加支架通畅率。
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