CAJ | 학술논문

目的评价进展期胃癌根治术后放化疗与单纯化疗的疗效及不良反应.方法搜集2004-2010年Ⅱ～Ⅳ(M0)期胃癌根治术后病例共183例,其中术后放化疗64例、单纯化疗119例.分析二者生存及不良反应,分层分析二者在不同分期、不同淋巴结转移个数、不同手术方式(D0、D1、D2术式)的生存差异.采用Kaplan-Meier法计算生存率并Logrank法检验和单因素分析,不良反应等行x2检验.结果随访率为87.8％,随访时间满3、5年例数分别为72、29例.术后放化疗和单纯化疗的1、3、5年生存率分别为86％、62％、55％和77％、53％、43％(P=0.079),3～4级胃肠道和血液学不良反应相似(P =0.363、0.617).单因素分析显示ⅢB～Ⅳ(M0)期、D0切除术、淋巴结转移个数＞6个者放化疗比单纯化疗生存获益(P =0.022、0.025、0.021).结论胃癌根治术后放化疗有延长生存趋势,不良反应可耐受.ⅢB～Ⅳ(M0)期、D0切除术、淋巴结转移个数＞6个者可从放化疗中获益.
목적 평개진전기위암근치술후방화료여단순화료적료효급불량반응.방법 수집2004-2010년Ⅱ～Ⅳ(M0)기위암근치술후병례공183례,기중술후방화료64례、단순화료119례.분석이자생존급불량반응,분층분석이자재불동분기、불동림파결전이개수、불동수술방식(D0、D1、D2술식)적생존차이.채용Kaplan-Meier법계산생존솔병Logrank법검험화단인소분석,불량반응등행x2검험.결과 수방솔위87.8％,수방시간만3、5년례수분별위72、29례.술후방화료화단순화료적1、3、5년생존솔분별위86％、62％、55％화77％、53％、43％(P=0.079),3～4급위장도화혈액학불량반응상사(P =0.363、0.617).단인소분석현시ⅢB～Ⅳ(M0)기、D0절제술、림파결전이개수＞6개자방화료비단순화료생존획익(P =0.022、0.025、0.021).결론 위암근치술후방화료유연장생존추세,불량반응가내수.ⅢB～Ⅳ(M0)기、D0절제술、림파결전이개수＞6개자가종방화료중획익.
Objective To investigate the therapeutic effects and toxic effects of radiochemotherapy versus chemotherapy alone in patients with advanced gastric cancer after gastrectomy.Methods A total of 183 patients with stage Ⅱ-Ⅳ (M0) gastric cancer,who received treatment after gastrectomy from 2004 to 2010,were included in the study.Of the 183 patients,64 received radiochemotherapy after gastrectomy,and 119 received chemotherapy alone after gastrectomy.The survival rates and hematological and gastrointestinal toxic effects were compared between the two groups;survival difference was also analyzed after the patients were stratified by TNM stage,number of metastatic lymph nodes,and extent of lymph node dissection (D0,D1,and D2).The Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis and univariate prognostic analysis;the chi-square test was used for comparing toxic effects between the two groups.Results The follow-up rate was 87.8％ ;72 patients were followed up for at least 3 years,and 29 patients for at least 5 years.The 1-,3-,and 5-year survival rates for the radiochemotherapy group were 86％,62％,and 55％,respectively,as compared with 77％,53％,and 43％ for the chemotherapy group (P =0.079).There were no significant differences in grade 3-4 hematological and gastrointestinal toxic effects between the two groups (P =0.363 and 0.617).The univariate analysis showed that radiochemotherapy had a significantly better survival benefit than chemotherapy alone in patients with stage ⅢB-Ⅳ (M0) gastric cancer,patients who underwent D0 lymph node dissection,and patients with more than 6 metastatic lymph nodes (P =0.022,0.025,and 0.021).Conclusions Compared with chemotherapy alone,radiochemotherapy tends to improve survival in patients with gastric cancer after gastrectomy,and its toxic effects are tolerable.The patients with stage ⅢB-Ⅳ (M0) gastric cancer,patients who undergo D0 lymph node dissection,and patients with more than 6 metastatic lymph nodes can benefit from radiochemotherapy.