姑息预后评分对晚期不可切除胃癌化疗适应性的预测价值

摘要

目的 探讨姑息预后评分(palliative prognostic score,PaP)对晚期不可切除胃癌化疗适应性的预测价值.方法 按照连续采样的方法收集自2015年5月至2016年5月于中国人民解放军武汉总医院普通外科确诊为胃癌,且对照2015 NCCN胃癌治疗指南相关标准确定不能根治性手术切除的病人44例,按照PaP相关评分及分组标准将44例病人分为A、B、C三组,每组病人按照随机数字表法决定是否接受化疗,比较组间及组内不同治疗方案病人生存时间的差异.结果 按照PaP相关评分及分组标准,将44例病人分为A组28例、B组12例、C组4例,三组病人的平均PaP评分分别为(4.65±1.33)分、(8.55±3.26)分、(14.36±5.70) 分.A、B、C三组中位生存时间分别为11个月、3个月和1个月,其中A组病人中位生存时间与B、C组比较,差异有统计学意义(P<0.01);A组28例病人,接受化疗15例,未化疗13例;化疗、未化疗病人的中位生存时间分别为16个月和9个月,差异有统计学意义(P<0.05),而B、C组病人化疗与否对病人生存时间的影响,差异无统计学意义(P>0.05).结论 PaP评分与晚期胃癌病人生存时间有关,不同评分级别病人生存时间有显著性差异,此外,PaP评分有助于临床适宜化疗晚期胃癌病人的筛选,PaP评分更能从化疗中获益.%Objective To investigate the predictive value of palliative prognostic(PaP) score in the treatment of patients with non-resectable gastric cancer.Methods The clinical data of patients diagnosed with stomach cancer and admitted into the Department of General Surgery,Wuhan General Hospital of Chinese People's Liberation Army from May 2015 to May 2016 were collected by the continuous sampling method.The lesions in all these patients couldn't be subjected to radical resection based on the 2015 NCCN stomach cancer treatment guidelines.All the included patients were divided into groups A,B and C according to the random number table method.The survival time was compared between groups.Results In accordance with the relevant PaP score and grouping criteria,there were 28 cases into group A,12 cases in group B,and 4 in group C.The median survival time of groups A,B and C was 11,3 and 1 month(s) respectively,and there was significant difference in the median survival time between group A and groups B or C (P<0.01).In group A,15 cases accepted chemotherapy,and 13 cases didn't,and the median survival time in chemotherapy and non-chemotherapy subgroups was 16 and 9 months respectively with the difference being statistically significant (P<0.05),but there was no statistically significant difference in groups B and C (P>0.05).Conclusions PaP score is associated with survival time of advanced gastric cancer patients.There was significant difference in the survival time among different grade levels.In addition,PaP score will help screen the patients with advanced gastric cancer for clinical chemotherapy.