进展期胃癌根治术后放化疗与单纯化疗预后分析

目的 评价进展期胃癌根治术后放化疗与单纯化疗的疗效及不良反应。方法 搜集2004—2010年Ⅱ~Ⅳ(M₀)期胃癌根治术后病例共183例,其中术后放化疗64例、单纯化疗119例。分析二者生存及不良反应,分层分析二者在不同分期、不同淋巴结转移个数、不同手术方式(D₀、D₁、D₂术式)的生存差异。采用Kaplan-Meier法计算生存率并Logrank法检验和单因素分析,不良反应等行χ²检验。结果 随访率为87.8%,随访时间满3、5年例数分别为72、29例。术后放化疗和单纯化疗的1、3、5年生存率分别为86%、62%、55%和77%、53%、43%(P=0.079),3~4级胃肠道和血液学不良反应相似(P=0.363、0.617)。单因素分析显示Ⅲ_B~Ⅳ(M₀)期、D₀切除术、淋巴结转移个数>6个者放化疗比单纯化疗生存获益(P=0.022、0.025、0.021)。结论 胃癌根治术后放化疗有延长生存趋势,不良反应可耐受。Ⅲ_B~Ⅳ(M₀)期、D₀切除术、淋巴结转移个数>6个者可从放化疗中获益。

Analysis of therapeutic effects of radiochemotherapy and chemotherapy alone in patients with advanced gastric cancer after gastrectomy

Objective To investigate the therapeutic effects and toxic effects of radiochemotherapy versus chemotherapy alone in patients with advanced gastric cancer after gastrectomy. Methods A total of 183 patients with stage Ⅱ—Ⅳ(M₀) gastric cancer, who received treatment after gastrectomy from 2004 to 2010, were included in the study. Of the 183 patients, 64 received radiochemotherapy after gastrectomy, and 119 received chemotherapy alone after gastrectomy. The survival rates and hematological and gastrointestinal toxic effects were compared between the two groups;survival difference was also analyzed after the patients were stratified by TNM stage, number of metastatic lymph nodes, and extent of lymph node dissection (D₀, D₁, and D₂). The Kaplan-Meier method was used for calculating survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparing toxic effects between the two groups. Results The follow-up rate was 87.8%;72 patients were followed up for at least 3 years, and 29 patients for at least 5 years. The 1-, 3-, and 5-year survival rates for the radiochemotherapy group were 86%, 62%, and 55%, respectively, as compared with 77%, 53%, and 43% for the chemotherapy group (P=0.079). There were no significant differences in grade 3—4 hematological and gastrointestinal toxic effects between the two groups (P=0.363 and 0.617). The univariate analysis showed that radiochemotherapy had a significantly better survival benefit than chemotherapy alone in patients with stage Ⅲ_B—Ⅳ(M₀) gastric cancer, patients who underwent D₀ lymph node dissection, and patients with more than 6 metastatic lymph nodes (P=0.022, 0.025, and 0.021). Conclusions Compared with chemotherapy alone, radiochemotherapy tends to improve survival in patients with gastric cancer after gastrectomy, and its toxic effects are tolerable. The patients with stage Ⅲ_B—Ⅳ(M₀) gastric cancer, patients who undergo D₀ lymph node dissection, and patients with more than 6 metastatic lymph nodes can benefit from radiochemotherapy.