进展期胃癌新辅助化疗疗效病理评估的探讨

发布时间：2018-04-03 13:33

  本文选题：胃癌　切入点：新辅助化疗　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨进展期胃癌患者新辅助化疗疗效的病理判断标准及各病理指标与生存预后的关系。方法:连续收集北京协和医院基本外科同一手术小组从2007年4月至2015年12月期间经过胃镜活检病理确诊的、接受新辅助化疗后、获得胃癌根治手术(均为R0切除、D2式淋巴结清扫)的87例进展期胃癌患者(T2-T4期,或者N1+)的临床病理资料,通过单因素、多因素统计分析探讨可能与生存预后相关的病理学因素,以探寻进展期胃癌新辅助化疗的病理学判效标准。结果:在87例患者中,男性66例(75.9%),女性21例(24.1%),中位年龄56岁。全部患者接受3-4周期新辅助化疗,其中采用Folfox方案、Xelox方案、SOX方案的患者分别为67例(77.0%)、15例(17.2%)、5例(5.8%)。化疗结束3-4周后均接受了胃癌根治手术(R0切除,D2式淋巴结清扫),其中79例继续接受术后化疗(中位化疗周期数为5周期)。术后病理结果显示:所有患者均显示了不同程度的病理组织学消退(Graded histologic regression,GHR,图1e);GHR≥50%、2/3、90%患者的比率分别为50.6%、34.5%、17.2%,4例患者出现了病理完全缓解(4.6%)。87例患者均得到随诊,中位随诊时间45个月(5~117个月);41例(47.1%)患者死亡,其中39例(44.8%)死于胃癌复发、进展。87例患者总生存(overall survival,OS)的中位数时间为97.5月,1年、2年、3年、5年、7年生存率分别为86.2%、68.5%、63.5%、54%、47.5%。85例患者疾病特异性总生存的中位数时间为73月(图1,b),1年、2年、3年、5年、7年疾病特异性生存率分别为87.1%、69%、63.4%、、54%、51.3%。单因素分析显示:原始肿瘤部位(p=0.009)、Lauren分型(p=0.002)、ypTNM分期(p=0.001)、以及GHR≥50%(p=0.022,)、66.7%(p=0.013)、90%(p=0.028)都与OS显著相关;多因素分析表明:ypTNM分期(HR 3.533,95%CI 1.886-6.617)和Lauren分型(HR 3.843,95%CI 1.443-10.237;HR 2.624,95%CI 0.698-9.863)与OS显著相关。结论:Lauren分型和新辅助化疗后ypTNM分期是进展期新辅助化疗的胃癌患者生存预后的重要的独立预测因素。GHR≥50%/50%标准可以作为新辅助化疗的主要判效标准,用于指导选择术后化疗方案。
[Abstract]:Objective: to investigate the pathological criteria of neoadjuvant chemotherapy in patients with advanced gastric cancer and its relationship with survival and prognosis.Methods: after receiving neoadjuvant chemotherapy from April 2007 to December 2015, the same surgical group of basic surgery in Beijing Union Union Hospital were continuously collected and diagnosed by gastroscopy biopsy.The clinicopathological data of 87 patients with advanced gastric cancer undergoing radical gastrectomy (all R0 resected D 2 lymph node dissection) with stage T2-T4 or N1 were obtained.Multivariate statistical analysis was conducted to explore the pathological factors related to survival and prognosis in order to find out the pathological criteria of neoadjuvant chemotherapy for advanced gastric cancer.Results: of the 87 patients, 66 were male and 21 were female. The median age was 56 years.All the patients received 3-4 cycles of neoadjuvant chemotherapy, of which 67 patients were treated with Folfox's Xelox regimen and Sox regimen, respectively. There were 15 patients with 17. 2% or 17. 2% and 5 cases with 5. 8% of neo-adjuvant chemotherapy with Folfox regimen or Xelox regimen.After 3 to 4 weeks of chemotherapy, all patients received radical resection of gastric cancer with R0 and D2 type lymph node dissection, 79 of them continued to receive postoperative chemotherapy (median chemotherapy period was 5 cycles).鏈�鍚庣梾鐞嗙粨鏋滄樉绀�:鎵，

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