晚期胃癌患者XELOX方案化疗后维持治疗的疗效及预后生存分析

摘要

目的 探讨晚期胃癌患者奥沙利铂联合卡培他滨(XELOX)方案化疗后维持治疗的疗效及预后生存因素.方法 回顾性分析118例晚期胃癌患者的临床资料,所有患者均采取XELOX方案化疗,并进行维持治疗.分析其短期疗效及不良反应发生情况,并采用Cox回归模型探讨影响患者预后的危险因素.结果 治疗后,临床总有效率为22.88％(27/118),疾病控制率为63.56％(75/118),共有7例(5.93％)患者发生3级不良反应,所有患者在化疗维持治疗期间均未出现4级不良反应及化疗相关性死亡.中位总生存期(OS)为12.59个月(95％CI:5.21～22.32),1年生存率为48.30％,2年生存率为26.27％.单因素分析结果显示:组织学分级、有无肝转移、有无淋巴结转移、近期疗效对晚期胃癌患者的中位OS有影响(P﹤0.05);而年龄、性别、胃癌部位、入院时ECOG评分对晚期胃癌患者的中位OS无影响(P﹥0.05).多元逐步Cox回归分析结果显示:组织学分级低、有淋巴结转移、肿瘤控制率差、有肝转移是影响晚期胃癌患者预后的独立危险因素(P﹤0.05).结论 对于晚期胃癌患者,XELOX方案化疗后的维持治疗是一种有效且不良反应程度相对较轻的治疗方案,且组织学分级低、有淋巴结转移、肿瘤控制率差、有肝转移是影响晚期胃癌患者预后的独立危险因素,临床中应当重视.%Objective To investigate the therapeutic effect of maintenance therapy after XELOX regimen as well as the prognostic factors in patients with advanced gastric cancer. Method The clinical data of 118 patients with advanced gastric cancer were retrospectively analyzed, all of which were administered with XELOX regimen followed by mainte-nance therapy. The short-term therapeutic efficacy and the incidence of adverse reactions in these patients were investigat-ed, and the Cox regression model was employed to explore the factors affecting the prognosis of patients. Result After treatment, the overall response rate was 22.88％(27/118) and disease control rate was 63.56％(75/118), and there were a total of 7 cases (5.93％) who developed grade 3 adverse reactions, though no grade 4 adverse reactions and chemotherapy-related deaths were observed during chemotherapy maintenance. The median overall survival (OS) was 12.59 months (95％CI: 5.21～22.32), the 1- and 2-year survival rates were 48.30％ and 26.27％, respectively. The univariate analysis showed that, histological grade, liver metastases, lymph node metastases and short-term efficacy were factors influencing the median OS in patients with advanced gastric cancer (P<0.05);while age, gender, lesion site and ECOG scores at ad-mission to hospital were not (P>0.05). In multivariate stepwise Cox regression analysis, it was found that low histological grade, positive lymph node metastases, poor tumor control rates, and positive liver metastases were independent prognos-tic risk factors in patients with advanced gastric cancer (P<0.05). Conclusion The maintenance therapy of XELOX regi-men after chemotherapy is effective for patients with advanced gastric cancer, with mild adverse reactions, besides, lower histologic grade, positive lymph node metastases, poor tumor poor control rate, and positive liver metastases are indepen-dent prognostic risk factors in patients with advanced gastric cancer.