伴有远处转移的胃癌手术治疗结果：一项来自监测、流行病学和最终结果（SEER）数据库的回顾性研究
Outcomes of surgery for gastric cancer with distant metastases: a retrospective study from the SEER database.
作者信息
Chen Jiaqi, Kong Yiyao, Weng Shanshan, Dong Caixia, Zhu Lizhen, Yang Ziru, Zhong Jing, Yuan Ying
机构信息
Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Department of Gastroenterology, The Second Affiliated Hospital, School of Medicine and Institute of Gastroenterology, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Oncotarget. 2017 Jan 17;8(3):4342-4351. doi: 10.18632/oncotarget.14027.
BACKGROUND
The role of surgical therapy in gastric cancer patients with distant metastases remains controversial. This retrospective analysis was performed to identify whether gastric cancer patients with distant metastases might benefit from surgery.
PATIENTS AND METHODS
A total of 5185 patients from the SEER database who were initially diagnosed with histologically confirmed gastric cancer with distant metastases from 2004 to 2009 were included. Patients were divided into the following three groups: patients who underwent resection of both the primary tumor and distant metastatic tumors ('PMTR' group), patients who only underwent resection of the primary tumor ('PTR' group) and patients who did not undergo any surgery ('No surgery' group). We employed the Kaplan-Meier analysis, the log-rank test and multivariate Cox proportional hazards regression models to estimate the survival time of the different groups.
RESULTS
A total of 5185 patients had a median survival time (MST) of 9.0 months. The improvement in survival of the 'PMTR' and 'PTR' groups was significantly different compared with that of the 'No surgery' group (MST, 12.0 vs 12.0 vs 9.0 months, respectively, P<0.001; 1-year survival rate, 49.6% vs 49.1% vs 30.1%, respectively, P<0.001; 3-year survival rate, 12.5% vs 15.1% vs 5.8%, respectively, P<0.001), whereas no significant difference was found between the 'PMTR' group and 'PTR' group (P=0.642). Multivariate Cox proportional analysis showed that surgery was an independent prognostic factor ('PMTR', hazard ratio (HR) =0.648, 95% confidence interval (CI) 0.574-0.733, P<0.001; 'PTR', HR=0.631, 95% CI 0.583-0.684, P<0.001).
CONCLUSIONS
This retrospective analysis demonstrated that combined PTR and metastasectomy or PTR alone were independent prognostic factors for survival improvement in gastric cancer patients with distant metastases. Because no statistically significant difference in survival was observed between the 'PMTR' group and 'PTR' group, PTR, which is a more minor surgery, might be more appropriate than PMTR in clinical practice for gastric cancer patients with distant metastases.
背景
手术治疗在伴有远处转移的胃癌患者中的作用仍存在争议。本回顾性分析旨在确定伴有远处转移的胃癌患者是否能从手术中获益。
患者与方法
纳入2004年至2009年来自监测、流行病学和最终结果（SEER）数据库的5185例最初经组织学确诊为伴有远处转移的胃癌患者。患者被分为以下三组：接受原发肿瘤和远处转移瘤切除的患者（“原发肿瘤及转移瘤切除”组）、仅接受原发肿瘤切除的患者（“原发肿瘤切除”组）和未接受任何手术的患者（“未手术”组）。我们采用Kaplan-Meier分析、对数秩检验和多变量Cox比例风险回归模型来估计不同组的生存时间。
结果
5185例患者的中位生存时间为9.0个月。“原发肿瘤及转移瘤切除”组和“原发肿瘤切除”组的生存改善与“未手术”组相比有显著差异（中位生存时间分别为12.0、12.0和9.0个月，P<0.001；1年生存率分别为49.6%、49.1%和30.1%，P<0.001；3年生存率分别为12.5%、15.1%和5.8%，P<0.001），而“原发肿瘤及转移瘤切除”组和“原发肿瘤切除”组之间未发现显著差异（P=0.642）。多变量Cox比例分析显示手术是一个独立的预后因素（“原发肿瘤及转移瘤切除”组，风险比（HR）=0.648，95%置信区间（CI）0.574 - 0.733，P<0.001；“原发肿瘤切除”组，HR = 0.631，95% CI 0.583 - 0.684，P<0.001）。
结论
本回顾性分析表明，原发肿瘤切除联合转移瘤切除术或单纯原发肿瘤切除术是伴有远处转移的胃癌患者生存改善的独立预后因素。由于“原发肿瘤及转移瘤切除”组和“原发肿瘤切除”组之间在生存方面未观察到统计学上的显著差异，对于伴有远处转移的胃癌患者，在临床实践中，作为一种创伤较小的手术，原发肿瘤切除术可能比原发肿瘤及转移瘤切除术更合适。
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