Long-term survival and prognostic factors in patients with metastatic gastric cancers treated with chemotherapy in the Japan Clinical Oncology Group (JCOG) study
Long-term survival and prognostic factors in patients with metastatic gastric cancers treated with chemotherapy in the Japan Clinical Oncology Group (JCOG) study
复制标题
DOI：
10.1093/jjco/hyh120
复制
发表时间：
2004-11-01
影响因子：
2.4
通讯作者：
Yamamoto, Seiichiro
中科院分区：
文献类型：
--
作者：
Yoshida, Motoki;Ohtsu, Atsushi;Yamamoto, Seiichiro
背景：晚期胃癌患者化疗后的长期生存率尚不清楚。本分析的目的是探讨转移性胃癌患者化疗治疗的预后因素，并确定长期survivor.Methods的特点：六百四十三例患者参加了四个阶段11研究和一个III期研究日本临床肿瘤组1985年1月至1997年4月。通过调整5项研究之间的患者资格，选择了497例患者（77%）进行分析。单因素和多因素分析采用对数秩检验和考克斯的比例风险models.Results：497例分析，39（8%）和11（2%）患者生存时间超过2年和5年，分别。多因素分析显示，较好的体能状态、少量的转移部位和肉眼可见的非硬结型肿瘤与较好的预后显著相关。11例5年生存者的特征显示8例仅主动脉旁淋巴结转移。这些患者中有8例接受胃切除术，化疗前进行，其他4例患者接受化疗成功后，实现降级。结论：这些结果表明，更好的性能状态，少量的转移部位和宏观非硬结型肿瘤的生存是独立的有利因素。少数5年生存者不能手术切除胃癌，大多数仅有腹腔淋巴结转移，化疗前或化疗后行胃切除。
Background: The long-term survival of patients after chemotherapy for advanced gastric cancer remains unclear. The aim of this analysis was to investigate prognostic factors for patients with metastatic gastric cancer treated by chemotherapy, and to identify the characteristics of long-term survivors.Methods: Six hundred and forty three patients were enrolled in four phase 11 studies and one phase III study by the Japan Clinical Oncology Group between January 1985 and April 1997. By adjusting patients' eligibility between the five studies, 497 patients (77%) were selected for the analysis. Univariate and multivariate analyses were performed using log-rank tests and Cox's proportional hazard model, respectively.Results: Of the 497 patients analyzed, 39 (8%) and 11 (2%) patients have survived longer than 2 and 5 years, respectively. By multivariate analysis, better performance status, a small number of metastatic sites and macroscopically non-scirrhous type tumors were significantly associated with better prognosis. Characteristics of the 11 5-year survivors revealed eight with para-aortic node metastases alone. Eight of these patients received gastrectomy; four underwent it before chemotherapy, and the other four patients received it after achieving downstaging with successful chemotherapy.Conclusions: These results demonstrated that better performance status, a small number of metastatic sites and macroscopically non-scirrhous type tumors are independent favorable factors for survival. There were a few 5-year survivors with unresectable gastric cancers, most of whom had only abdominal lymph node metastases and received gastrectomy before or after chemotherapy.