丁平安, 张志栋, 杨沛刚, 田园, 郭洪海, 刘洋, 王冬, 李勇, 赵群. 进展期胃癌新辅助化疗期间伴急性上消化道出血患者的生存分析[J]. 中国肿瘤临床, 2020, 47(24): 1254-1260. DOI: 10.3969/j.issn.1000-8179.2020.24.049
引用本文: 丁平安, 张志栋, 杨沛刚, 田园, 郭洪海, 刘洋, 王冬, 李勇, 赵群. 进展期胃癌新辅助化疗期间伴急性上消化道出血患者的生存分析[J]. 中国肿瘤临床, 2020, 47(24): 1254-1260. DOI: 10.3969/j.issn.1000-8179.2020.24.049
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Ping'an Ding, Zhidong Zhang, Peigang Yang, Yuan Tian, Honghai Guo, Yang Liu, Dong Wang, Yong Li, Qun Zhao. Prognostic analysis of advanced gastric cancer patients with acute upper gastrointestinal bleeding during neoadjuvant chemotherapy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2020, 47(24): 1254-1260. DOI: 10.3969/j.issn.1000-8179.2020.24.049
Citation: Ping'an Ding, Zhidong Zhang, Peigang Yang, Yuan Tian, Honghai Guo, Yang Liu, Dong Wang, Yong Li, Qun Zhao. Prognostic analysis of advanced gastric cancer patients with acute upper gastrointestinal bleeding during neoadjuvant chemotherapy[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2020, 47(24): 1254-1260. DOI: 10.3969/j.issn.1000-8179.2020.24.049
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进展期胃癌新辅助化疗期间伴急性上消化道出血患者的生存分析

Prognostic analysis of advanced gastric cancer patients with acute upper gastrointestinal bleeding during neoadjuvant chemotherapy

    摘要
  • 摘要:
      目的  探讨进展期胃癌新辅助化疗期间合并急性上消化道出血(acute upper gastrointestinal bleeding, AUGB)患者的临床特征和生存预后。
      方法  回顾性分析河北医科大学第四医院自2015年1月至2017年1月行术前新辅助化疗的476例胃癌患者, 筛选出新辅助治疗期间出现AUGB的患者, 分析临床特征及影响预后的因素。
      结果  476例胃癌患者行新辅助化疗期间出现AUGB者35例(7.35%), 其中经补液止血保守治疗好转者6例, 内镜下成功止血者5例, 血管造影栓塞术成功止血者7例, 余17例患者均行剖腹探查手术止血。全组患者3年总生存率(overall survival, OS)为65.13%, 3年无病生存率(disease-free survival, DFS)为60.71%。其中出现AUGB者3年OS为48.57%, 3年DFS为42.86%, 而未出现AUGB者3年OS、DFS分别为66.44%、62.13%, 两组患者的3年OS、DFS差异均具有统计学意义(P=0.033、P=0.025)。Cox比例风险模型多因素分析发现, 肿瘤组织学类型为低分化-未分化型(P=0.004、P=0.008)、肿瘤cTNM分期为Ⅲ期(P=0.002、P=0.013)和出现AUGB后未继续行化疗治疗(P=0.003、P=0.005)是影响AUGB患者预后及复发的独立危险因素。
      结论  进展期胃癌患者进行新辅助化疗期间出现AUGB与多种危险因素有关, 此类患者需引起临床重视; 新辅助化疗期间出现AUGB后需积极对症止血治疗, 止血成功后继续化疗才可能延长此类患者生存期。

     

    Abstract:
      Objective  To investigate the clinical characteristics and survival prognosis of patients with advanced gastric cancer who develop acute upper gastrointestinal bleeding (AUGB) during neoadjuvant chemotherapy.
      Methods  A retrospective analysis of 476 patients with gastric cancer who received preoperative neoadjuvant chemotherapy between January 2015 and January 2017 at The Fourth Hospital of Hebei Medical University was performed.Patients who developed AUGB during neoadjuvant therapy were screened, and the clinical characteristics and factors affecting prognosis were analyzed.
      Results  Thirty-five (7.35%) of the 476 patients with gastric cancer developed AUGB during neoadjuvant chemotherapy.Bleeding was conservatively managed in 6 cases by rehydration hemostasis. Bleeding was successfully stopped in 5 cases via endoscopy and in 7 cases by interventional angiography and embolization.Bleeding was stopped in the remaining 17 patients by performing exploratory laparotomy.The 3-year overall survival (OS) rate in the whole group of patients was 65.13%, and the 3-year disease-free survival (DFS) rate was 60.71%.The 3-year OS rate in patients who developed AUGB was 48.57%, and the 3-year DFS rate in this group was 42.86%.In patients without AUGB, the 3-year OS and DFS rates were 66.44% and 62.13%, respectively.The differences in the 3-year OS and DFS rates between the two groups were significant (P= 0.033 and P=0.025, respectively).Multivariate analysis using a Cox proportional hazard model revealed that poorly differentiated/undifferentiated histology (P=0.004 and P=0.008, respectively), cTNM stage Ⅲ(P=0.002 and P=0.013, respectively), and failure to continue chemotherapy after the occurrence of AUGB (P=0.003 and P=0.005, respectively) were independent factors affecting the prognosis of patients and the recurrence of AUGB.
      Conclusions  The occurrence of AUGB during neoadjuvant chemotherapy in advanced gastric cancer patients is related to a variety of risk factors, and clinical attention should be paid to such patients.At the same time, AUGB occurring during neoadjuvant chemotherapy requires active hemostatic treatment, and the continuation of chemotherapy after successful hemostasis may prolong the survival of such patients.

     

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