经导管肝动脉化疗栓塞术联合全身化疗治疗胃癌肝转移的临床应用价值

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英文篇名：Clinical Application Value of Transcather Arterial Chemoembolization in Combination with Chemotherapy in Treatment of Gastric Cancer with Liver Metastasis 作者：徐玉良 ; 顾康生 英文作者：XU Yuliang;GU Kangsheng;Department of Medical Oncology,The First Affiliated Hospital of Anhui Medical University; 关键词：经导管肝动脉化疗栓塞术 ; 化疗 ; 胃癌 ; 肝转移 英文关键词：Transcather arterial chemoembolization;;Chemotherapy;;Gastric cancer;;Hepatic metastases 中文刊名：LCFS 英文刊名：Journal of Clinical Radiology 机构：安徽医科大学第一附属医院肿瘤内科;安徽济民肿瘤医院肿瘤内二科; 出版日期：2019-05-20 出版单位：临床放射学杂志 年：2019 期：v.38;No.346 语种：中文; 页：LCFS201905040 页数：6 CN：05 ISSN：42-1187/R 分类号：152-157

摘要

目的探讨经导管肝动脉化疗栓塞术(TACE)联合全身化疗与单纯全身化疗治疗胃癌肝转移患者的疗效差异。方法搜集本院收治的无外科治疗指征的胃癌肝转移患者68例,根据患者是否联合TACE治疗分为观察组(n=32)和对照组(n=36)。对比两组患者的近期疗效、毒副反应发生率、生存率及KPS评分情况;同时对观察组预后影响因素进行单因素和多因素分析。结果两组近期疗效有效率比较,差异具有统计学意义(χ~2=5.785,P=0.016)。两组患者毒副反应主要为恶心、呕吐、口腔炎、转氨酶升高和骨髓抑制,两组毒副反应发生率比较,差异无统计学意义(P>0.05)。对照组和观察组0.5年、1年、2年、3年累积生存率分别为66.6%、48.7%、19.8%、0和84.4%、62.5%、28.1%、15.6%,中位生存时间分别为12个月和13个月,两组总体生存率比较,差异具有统计学意义(χ~2=4.455,P=0.035)。入组前两组KPS评分比较,差异无统计学意义(P>0.05),入组半年后,观察组KPS评分优于对照组,差异具有统计学意义(P<0.05)。单因素分析显示肿瘤分化程度、白蛋白、肝转移程度与患者预后相关(P<0.05),而年龄、性别、胃癌发生部位、癌胚抗原(CEA)、甲胎蛋白(AFP)、CA199与患者预后没有相关(P>0.05);多因素分析显示肿瘤分化程度和肝转移程度为患者预后的独立影响因素(P<0.05)。结论 TACE联合全身化疗治疗胃癌肝转移患者优于单纯全身化疗,可改善患者近期疗效、生存周期和生活质量,且不增加毒副作用发生率,值得临床推广。
        Objective To explore the difference of the curative effect between transcather arterial chemoembolization(TACE) in combination with chemotherapy and single chemotherapy in treatment of gastric cancer with liver metastasis. Methods A total of 68 patients with gastric cancer with liver metastasis without surgical indications were collected and divided into observation group(n=32) and control group(n=36),according to whether or not they receive TACE. Short term effect,incidence of adverse reactions,survival rate,and KPS score between the two groups were compared. All risk factors of prognosis of the observation group were evaluated with univariate and multivariate analysis. Results The difference of short-term efficacy between the two groups was statistically significant(χ~2=5.785,P=0.016). The main toxic and side effects in the two groups included nausea,emesis,stomatitis,transaminase elevation,and bone marrow suppression. The differences of incidences rate of toxic and side effects between the two groups were all not statistically significant(P>0.05). The 0.5,1,2,and 3 year cumulative survival rate of the control group and observation group were 66.6%,48.7%,19.8%,0% and 84.4%,62.5%,28.1%,15.6%,respectively. The median survival time of control group and observation group were 12 months and 13 months,respectively. The difference of overall survival between the two groups was statistically significant(χ~2=4.455,P=0.035). The difference of KPS score between the two groups before treatment was not statistically significant(P>0.05). The difference of KPS score between the two groups six months after treatment was statistically significant(P<0.05). Simple factor analysis displayed that the degree of tumor differentiation,albumin,and degree of liver metastasis were related to prognosis(P<0.05). However,age,sex,location of gastric cancer,CEA,AFP,and CA199 were not related to prognosis(P>0.05). Multi-factor analysis showed that the degree of tumor differentiation and degree of liver metastasis were independent influencing factors for prognosis(P<0.05). Conclusion TACE in combination with chemotherapy is better than the single chemotherapy in treatment of gastric cancer with liver metastasis. It can improve the short term effect,life cycle,and quality of life,without increase of the incidences of toxic side effects simultaneously,and is worthy of clinical application.

引文

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