本文選題：胃癌　切入點(diǎn)：新輔助化療　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討進(jìn)展期胃癌患者新輔助化療療效的病理判斷標(biāo)準(zhǔn)及各病理指標(biāo)與生存預(yù)后的關(guān)系。方法:連續(xù)收集北京協(xié)和醫(yī)院基本外科同一手術(shù)小組從2007年4月至2015年12月期間經(jīng)過(guò)胃鏡活檢病理確診的、接受新輔助化療后、獲得胃癌根治手術(shù)(均為R0切除、D2式淋巴結(jié)清掃)的87例進(jìn)展期胃癌患者(T2-T4期,或者N1+)的臨床病理資料,通過(guò)單因素、多因素統(tǒng)計(jì)分析探討可能與生存預(yù)后相關(guān)的病理學(xué)因素,以探尋進(jìn)展期胃癌新輔助化療的病理學(xué)判效標(biāo)準(zhǔn)。結(jié)果:在87例患者中,男性66例(75.9%),女性21例(24.1%),中位年齡56歲。全部患者接受3-4周期新輔助化療,其中采用Folfox方案、Xelox方案、SOX方案的患者分別為67例(77.0%)、15例(17.2%)、5例(5.8%)。化療結(jié)束3-4周后均接受了胃癌根治手術(shù)(R0切除,D2式淋巴結(jié)清掃),其中79例繼續(xù)接受術(shù)后化療(中位化療周期數(shù)為5周期)。術(shù)后病理結(jié)果顯示:所有患者均顯示了不同程度的病理組織學(xué)消退(Graded histologic regression,GHR,圖1e);GHR≥50%、2/3、90%患者的比率分別為50.6%、34.5%、17.2%,4例患者出現(xiàn)了病理完全緩解(4.6%)。87例患者均得到隨診,中位隨診時(shí)間45個(gè)月(5~117個(gè)月);41例(47.1%)患者死亡,其中39例(44.8%)死于胃癌復(fù)發(fā)、進(jìn)展。87例患者總生存(overall survival,OS)的中位數(shù)時(shí)間為97.5月,1年、2年、3年、5年、7年生存率分別為86.2%、68.5%、63.5%、54%、47.5%。85例患者疾病特異性總生存的中位數(shù)時(shí)間為73月(圖1,b),1年、2年、3年、5年、7年疾病特異性生存率分別為87.1%、69%、63.4%、、54%、51.3%。單因素分析顯示:原始腫瘤部位(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)都與OS顯著相關(guān);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)與OS顯著相關(guān)。結(jié)論:Lauren分型和新輔助化療后ypTNM分期是進(jìn)展期新輔助化療的胃癌患者生存預(yù)后的重要的獨(dú)立預(yù)測(cè)因素。GHR≥50%/50%標(biāo)準(zhǔn)可以作為新輔助化療的主要判效標(biāo)準(zhǔn),用于指導(dǎo)選擇術(shù)后化療方案。
[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悗鐥呯悊緇撴灉鏄劇ず:鎵，

本文編號(hào)：1705404