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目的:探讨晚期胃癌患者二线化疗的预后因素,筛选二线化疗的最佳人群。方法:回顾性分析256例接受二线化疗的晚期胃癌患者,采用Kaplan-Meier法计算生存率,Log-rank检验比较各亚组生存率,采用Cox比例分析模型作临床病理特征对生存率影响的单因素和多因素分析。结果:二线化疗的客观有效率18.0%,中位至进展时间(TTP)3.0个月,中位生存期(OS)8.1个月,1年生存率24.4%。多因素分析发现,分化程度(RR=1.33;95%CI:1.02～1.74;P=0.04)、一线化疗的TTP(RR=2.12;95%CI:1.59～2.83;P=0.00)、二线化疗前PS评分(RR=5.42;95%CI:3.65～8.05;P=0.00)和血红蛋白(RR=3.56;95%CI:2.49～5.09;P=0.00)是晚期胃癌二线化疗的独立预后因素。根据患者含预后不良因素的个数,分为低危(0)、中危(1～2)和高危(3～4)3组,3组的中位生存期分别为10.2、6.4和3.3个月,1年生存率分别为39.2%和8.5%,0,P=0.00。结论:影响晚期胃癌二线化疗的独立预后因素包括分化程度、二线化疗前PS评分、血红蛋白和一线化疗的TTP,可作为筛选晚期胃癌二线化疗适宜人群的有效指标。
Objective: To investigate the prognostic factors of second-line chemotherapy in patients with advanced gastric cancer and to screen the optimal population for second-line chemotherapy. Methods: A total of 256 patients with advanced gastric cancer receiving second-line chemotherapy were retrospectively analyzed. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was used to compare the survival rate of each subgroup. Cox proportional hazards model was used to evaluate the clinical survival rate Factors and multivariate analysis. Results: The objective response rate of second-line chemotherapy was 18.0%, median to progression-time (TTP) 3.0 months, median survival (OS) 8.1 months and 1-year survival rate 24.4%. In the multivariate analysis, TTP (RR = 2.12; 95% CI: 1.59-2.83; P = 0.00) in the first-line chemotherapy was significantly higher than that before the second-line chemotherapy (RR = 1.33; 95% CI: 1.02-1.74; PS score (RR = 5.42; 95% CI: 3.65-8.05; P = 0.00) and hemoglobin (RR = 3.56; 95% CI: 2.49-5.09; P = 0.00) were independent predictors of second-line chemotherapy for advanced gastric cancer. According to the number of patients with poor prognosis, the patients were divided into low risk (0), intermediate risk (1 to 2) and high risk (3 to 4) groups. The median survival time was 10.2, 6.4 and 3.3 respectively Month, 1-year survival rates were 39.2% and 8.5%, 0, P = 0.00. CONCLUSION: The independent prognostic factors of second-line chemotherapy for advanced gastric cancer include differentiation degree, PS score before second-line chemotherapy, hemoglobin and TTP of first-line chemotherapy, which can be used as effective indicators for screening second-line chemotherapy for advanced gastric cancer.