| Purpose: Gastric cancer has a poor prognosis. The majority of patients will relapse after definitive surgery, and 5-year survival after surgery remains poor. The role of adjuvant therapy in gastric cancer has been controversial given the lack of significant survival benefit in many randomized studies and meta-analysis so far. And controversies still remain regarding the prognostic factors as well as the outcome in the adjuvant setting. So we choose the appropriate cases to evaluate the effect of adjuvant chemotherapy. In the mean time, using univariate and multivariate analyses to identify the prognosis value of the clinic pathological factors of gastric cancer, we expect to find some undocumented prognostic factors and create the individual risk assessment model for predicting the prognosis of the patients with gastric cancer.Material and method: Between September 1994 and September 2004, a total of 573 patients with gastric adenocarcinoma, who received adjuvant chemotherapy after gastrectomy in the general hospital of PLA, were included in the studies. The data concerning surgical treatment, pathological factors, regimens of chemotherapy and outcome were collected. The univariate and multivariate analyses were applied to evaluate the prognostic factors. 1-year, 3-year and 5-year survival rates were calculated by Kaplan-Meier curve method, univariate analysis was done through Log-rank and multiple factors comparison through Cox regression analysis. All tests were performed at the 0.05 level of significances. Statistical analysis was completed using the SPSS 12.0 statistic software.Result: 573 patients with gastric cancer were registered in this study. The ratio of male to female is 3.98:1. The median follow-up time of the patients was17 months (1-120 Mon). 299 cases died 159 censored, 115 still alive. The distribution of the age was 53.13±11.55ys. The overall survival rate for 1, 3, 5years was 83.48%, 46.15%, 35.59% respectively. The 5-year survival rates of patients in pathologic TNM (pTNM) stage la, I b, II, Ilia, Illb and IV were 100.0%, 91.7%, 53.6%, 37.8%, 11.0%, 9.8%, respectively (P <0.01). Of all 14 regimens, FAM, PELF, HFP, ELF and FO were the most widely used regimen. Significant differences of 5-years survival rate were found among the 14 regimens (p=0.004) without considering pTNM factors.From the univariate analysis, gender, hematemesis or melena, history of atrophic gastritis or gastric ulcer, blood platelet level, blood hemoglobin, blood carcino-embryonic antigen level, tumor location, tumor diameter, macroscopic appearance, depth of invasion, lymph node metastasis, ratio of metastatic to retrieved lymph nodes (N ratio), remote metastasis, infiltration to esophagus or duodenum, positive margins, degrees of radical operations, adjuvant chemotherapy, were found to be significantly associated with the cumulative survival rate.Of the variables selected by the univariate analysis, only seven (ratio of metastatic to retrieved lymph nodes, depth of invasion, remote metastasis ,blood platelet level, infiltration to esophagus or duodenum, hematemesis or Melena, blood carcino-embryonic antigen level) were recognized as significant prognostic factors.Conclusion:1. Adjuvant chemotherapy is not considered to be of significant benefit in our study compared with other researches with similar patient characteristics.2. Although no drug or regimen is definitely effective, of all the chemotherapy regimens, PELF seems to be most active;continuous intravenous infusion of 5-fluorouracil may be more effective compared with tradiationalinfusion.3. Ratio of metastatic to retrieved lymph nodes, depth of invasion, remote metastasis, blood platelet level, infiltration to esophagus or duodenum, hematemesis or melena, blood carcino-embryonic antigen level have been recognized as significant prognostic factors, in which ratio of metastatic to retrieved lymph nodes is more predictable than the number of metastatic lymph nodes for the prognosis of gastric cancer and can be regarded as the most important factor.4. We founded the equation for risk factors for prognosis originally: [h(t,Xi)]=h0(t)exp(0.692xi+0.583x2+0.914x3+0.833x4+0.594x5-0.501x6+0.369x7)...
|
PDF Full Text Request