Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, Athens, Greece.
BMC Cancer. 2012 Jun 21;12:264. doi: 10.1186/1471-2407-12-264.
Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit.
The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis.
The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60-70 vs. 90-100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis.
Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients.
姑息性手术加术后化疗是治疗 IV 期胃癌的一种具有挑战性的方法，但必须根据可能的临床获益仔细选择患者。
回顾性分析了 218 例经组织学诊断为胃腺癌并接受姑息性手术加术后化疗的患者的病历。通过多变量分析评估了 12 个潜在的预后变量（包括肿瘤 DNA 指数和血清 IgG 抗幽门螺杆菌（HP）抗体）对总生存期的影响。
中位生存期为 13.25 个月[95%置信区间（CI）12.00，14.50]。发现 3 个因素对生存有独立影响：体能状态（PS）[PS 60-70 与 90-100 HR 1.676；CI 1.171-2.398，p=0.005]、肝转移（HR 1.745；CI 1.318-2.310，p<0.001）和图像细胞术评估的 DNA 指数（2.2-3.6 与>3.6 HR 3.059；CI 2.185-4.283，p<0.001 和<2.2 与>3.6 HR；4.207 CI 2.751-6.433 <0.001）。HP 感染无论在单变量还是多变量分析中均未对生存产生统计学显著影响。
在接受姑息性胃切除术和术后化疗治疗的 IV 期胃癌患者中，较差的治疗前 PS、肝转移和高 DNA 指数是与不良生存结果相关的因素。HP 感染对这些患者的生存没有影响。
