一线姑息化疗后IV期胃癌患者的预后因素分析及预后模型设计
Analysis of Prognostic Factors and Design of Prognosis Model for Patients with Stage IV Gastric Cancer Following First-Line Palliative Chemotherapy.
作者信息
Zhou Qiyin, Lan Xi, Li Ni, Yuan Daozu, Zhang Jiliang
机构信息
Department of Oncology, Chengdu Seventh People Hospital (Chengdu Tumorous Disease Quality Control Center), Chengdu 610000, People's Republic of China.
出版信息
Cancer Manag Res. 2020 Oct 22;12:10461-10468. doi: 10.2147/CMAR.S263320. eCollection 2020.
BACKGROUND
This study was to investigate the prognostic factors of patients with advanced gastric cancer and described a sample model to better differentiate the patients who could better benefit from palliative chemotherapy.
PATIENTS AND METHODS
In this retrospective study, 112 gastric cancer patients at stage IV following first-line chemotherapy were enrolled from July 2013 to September 2019. The clinical factors including age, sex, ECOG, pathologic types, metastatic sites, blood indexes, response of first-line chemotherapy, and survival were collected. The treatment responses were evaluated using the response evaluation criteria in solid tumors (RECIST). The survival curves were drawn by the Kaplan-Meier method, and the independent prognostic factors of overall survival (OS) were analyzed by Cox proportional hazards regression model.
RESULTS
In this study, the median overall survival (mOS) of gastric cancer patients was 10.5 months, the disease remission rate (PR) was 21.4%, and the disease control rate (DCR) was 86.6%. Multivariate analysis identified 5 independent prognostic factors: peritoneal metastasis [ = 0.002; hazard risk (HR), 2.394; 95% CI 1.394-4.113], hemoglobin <90g/L [ = 0.001; hazard risk (HR), 2.674; 95% CI 1.536-4.655], LDH ≥225 U/L [ = 0.033; hazard risk (HR), 1.818; 95% CI 1.409-3.150], and 3 times higher level of CEA [ = 0.006; hazard risk (HR), 2.123; 95% CI 1.238-3.640] along with CA199 [ = 0.005; hazard risk (HR), 2.544; 95% CI 1.332-4.856] than upper limit of normal. Based on the obtained data, a prognostic index was constructed, dividing the patients into three risk groups: low ( = 67), intermediate ( = 35), and high-risk group ( = 10). The mOS for low, intermediate, and high-risk groups was 13.9 months (95% CI 10.7-17.1), 8.1 months (95% CI 5.7-10.4), and 3.9 months (95% CI 2.6-5.3), respectively, whereas the 1-year survival rate was 56.4%, 20.0%, and 0.0%, respectively ( < 0.001).
CONCLUSION
This model should facilitate the prediction of treatment outcomes and then individualized treatment of advanced gastric cancer patients.
背景
本研究旨在探讨晚期胃癌患者的预后因素，并描述一个样本模型，以更好地区分能从姑息化疗中更显著获益的患者。
患者与方法
在这项回顾性研究中，2013年7月至2019年9月纳入了112例接受一线化疗后的IV期胃癌患者。收集了包括年龄、性别、美国东部肿瘤协作组（ECOG）评分、病理类型、转移部位、血液指标、一线化疗反应及生存情况等临床因素。采用实体瘤疗效评价标准（RECIST）评估治疗反应。采用Kaplan-Meier法绘制生存曲线，并通过Cox比例风险回归模型分析总生存（OS）的独立预后因素。
结果
本研究中，胃癌患者的中位总生存期（mOS）为10.5个月，疾病缓解率（PR）为21.4%，疾病控制率（DCR）为86.6%。多因素分析确定了5个独立预后因素：腹膜转移[P = 0.002；风险比（HR），2.394；95%置信区间（CI）1.394 - 4.113]、血红蛋白<90g/L[P = 0.001；风险比（HR），2.674；95%CI 1.536 - 4.655]、乳酸脱氢酶（LDH）≥225U/L[P = 0.033；风险比（HR），1.818；95%CI 1.409 - 3.150]，以及癌胚抗原（CEA）水平高于正常上限3倍[P = 0.006；风险比（HR），2.123；95%CI 1.238 - 3.640]，同时糖类抗原199（CA199）[P = 0.005；风险比（HR），2.544；95%CI 1.332 - 4.856]高于正常上限。根据所得数据构建了一个预后指数，并将患者分为三个风险组：低风险组（n = 67）、中风险组（n = 35）和高风险组（n = 10）。低、中、高风险组的mOS分别为13.9个月（95%CI 10.7 - 17.1）、8.1个月（95%CI 5.7 - 10.4）和3.9个月（95%CI 2.6 - 5.3），而1年生存率分别为56.4%、20.0%和0.0%（P < 0.001）。
结论
该模型应有助于预测晚期胃癌患者的治疗结果，进而实现个体化治疗。
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