589 例晚期胃癌二线或三线化疗患者口服摄入的临床影响：一项回顾性队列研究。

Clinical Impact of Oral Intake in Second-line or Third-line Chemotherapy for 589 Patients With Advanced Gastric Cancer: A Retrospective Cohort Study.

机构信息

Departments of Clinical Oncology.

Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.

出版信息

Am J Clin Oncol. 2021 Aug 1;44(8):388-394. doi: 10.1097/COC.0000000000000835.

DOI:10.1097/COC.0000000000000835

PMID:34028372

Abstract

OBJECTIVES

Insufficient oral intake in advanced gastric cancer (AGC) limits the use of several drugs. We aimed to determine the oral intake status of patients with AGC during later-line chemotherapy.

MATERIALS AND METHODS

We retrospectively evaluated data of patients with AGC who experienced disease progression during first-line chemotherapy administered from January 2012 to December 2018 in a single institution. We defined "insufficient oral intake" as requiring daily intravenous fluids or hyperalimentation. Multivariate logistic regression was performed to identify oral intake-related factors.

RESULTS

Among 589 included patients, at disease progression during first-line, second-line, and third-line chemotherapy, 78.3% (461), 53.3% (314), and 30.4% (179) of patients, respectively, exhibited sufficient oral intake. Fourth-line chemotherapy was initiated for 22.2% (131) of patients, with 20.0% (118) exhibiting sufficient oral intake. During second-line and third-line chemotherapy, 11/67 (16%) and 2/39 (5%) patients, respectively, exhibited improvements in oral intake; 85/428 (19.9%) and 70/259 (27.0%), respectively, exhibited deteriorations in oral intake. Factors correlated to deterioration in oral intake during second-line chemotherapy were poor Eastern Cooperative Oncology Group Performance Status (odds ratio, 4.32; P<0.001), moderate or severe ascites (1.96; P=0.045), peritoneal metastasis (2.12; P=0.029), prior palliative surgery (3.41; P=0.003), and high neutrophil-to-lymphocyte ratio (3.09; P<0.001); those correlated to deterioration in oral intake during third-line chemotherapy were poorly differentiated pathology (2.52; P=0.025) and high neutrophil-to-lymphocyte ratio (2.65; P=0.006).

CONCLUSION

As later-line chemotherapy is ineffective in improving oral intake in patients with AGC, careful adaptation of regimens is required for patients at risk for impaired oral intake.

摘要

目的

晚期胃癌（AGC）患者摄入不足会限制多种药物的使用。本研究旨在明确晚期胃癌患者在接受后线化疗时的口服摄入情况。

材料与方法

回顾性分析了 2012 年 1 月至 2018 年 12 月期间在我院接受一线化疗后疾病进展的 AGC 患者的数据。我们将“摄入不足”定义为需要每日静脉补液或高营养支持。采用多因素逻辑回归分析确定与口服摄入相关的因素。

结果

在一线、二线和三线化疗时疾病进展的 589 例患者中，分别有 78.3%（461 例）、53.3%（314 例）和 30.4%（179 例）患者具备充足的口服摄入。有 22.2%（131 例）的患者接受了四线化疗，其中 20.0%（118 例）患者具备充足的口服摄入。在二线和三线化疗时，分别有 11/67（16%）和 2/39（5%）患者的口服摄入得到改善，85/428（19.9%）和 70/259（27.0%）患者的口服摄入出现恶化。二线化疗时，一般状况 ECOG 评分较差（比值比，4.32；P<0.001）、中重度腹水（1.96；P=0.045）、腹膜转移（2.12；P=0.029）、姑息性手术史（3.41；P=0.003）和高中性粒细胞与淋巴细胞比值（3.09；P<0.001）是口服摄入恶化的相关因素；三线化疗时，分化程度差（2.52；P=0.025）和高中性粒细胞与淋巴细胞比值（2.65；P=0.006）是口服摄入恶化的相关因素。