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早期肿瘤退缩和肿瘤反应深度与曲妥珠单抗联合化疗一线治疗人表皮生长因子受体2阳性晚期胃癌患者疗效及预后的关系

Relationship of early tumor shrinkage and depth of response with the prognosis and treatment effect of trastuzumab combined with chemotherapy as first-line treatment in advanced gastric cancer patients with epidermal growth factor receptor 2 positive

摘要:

目的:探讨早期肿瘤退缩(ETS)和肿瘤反应深度(DpR)与曲妥珠单抗联合化疗一线治疗人表皮生长因子受体2(HER-2)阳性晚期胃癌患者的疗效及预后的关系。方法:回顾性分析2008年1月1日至2017年12月31日间就诊于浙江大学医学院附属第二医院的23例组织学明确为胃腺癌、影像学证实为转移性胃癌患者的临床病理资料。采用Kaplan-Meier法和Log rank检验进行生存分析,采用Cox回归分析对可能影响患者预后的因素进行分析。结果:23例患者中,客观有效率为43.5%,疾病控制率为82.6%。单因素分析显示,ETS≥20%和ETS<20%患者的中位无进展生存时间(PFS)分别为13.0和4.5个月,差异有统计学意义( P<0.001);ETS≥20%和ETS<20%患者中位总生存时间(OS)分别为26.8和10.1个月,差异有统计学意义( P<0.001)。DpR≥15%和DpR<15%患者的中位PFS分别为13.0和4.5个月,差异有统计学意义( P=0.001);DpR≥15%和DpR<15%患者的中位OS分别为26.8和9.5个月,差异有统计学意义( P<0.001)。多因素分析显示,ETS为影响患者PFS的独立因素( P=0.030),肿瘤部位和美国东部肿瘤协作组评分为影响患者OS的独立因素(均 P<0.05)。 结论:ETS和DpR可能有效预测曲妥珠单抗联合化疗一线治疗HER-2阳性晚期胃癌的疗效和预后。

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abstracts:

Objective:To explore the relationship of early tumor shrinkage (ETS) and depth of response (DpR) with the prognosis and treatment effect of trastuzumab combined with chemotherapy as first-line treatment in advanced gastric cancer with epidermal growth factor receptor 2 (HER-2) positive.Methods:We retrospectively analyzed the clinical and pathological data of 23 patients with metastatic gastric adenocarcinoma diagnosed by imaging in The Second Affiliated Hospital of Zhejiang University School of Medicine from January 1st, 2008 to December 31th, 2017. Kaplan-Meier method and the log-rank test were used for the survival analysis. Cox regression was used to analyze the factors associated with prognosis.Results:The objective response rate (ORR) of the 23 patients was 43.5% and the disease control rate (DCR) was 82.6%. Univariate analysis showed the median progress-free survival (mPFS) of ETS≥20% and ETS<20% were 13.0 months and 4.5 months, respectively, with statistical significance ( P<0.001). The median overall survival (mOS) of ETS≥20% and ETS<20% were 26.8 months and 10.1 months, respectively, with statistical significance ( P<0.001). The median progress-free survival (mPFS) of DpR≥15% and DpR<15% were 13.0 months and 4.5 months, respectively, with statistical significance ( P=0.001). The median overall survival (mOS) of DpR≥15% and DpR<15% were 26.8 months and 9.5 months, respectively, with statistical significance ( P<0.001). Multivariable Cox regression analysis revealed ETS was an independent factor of PFS ( P=0.030), tumor site and Eastern Cooperative Oncology Group (ECOG) score were independent factors of OS ( P<0.05). Conclusion:ETS and DpR might be used to predict the treatment efficacy and prognosis of trastuzumab combined with chemotherapy as the first-line treatment of HER-2 positive gastric cancer.

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作者: 朱柠 [1] 陈佳琦 [1] 杨梦园 [1] 程怡 [1] 袁瑛 [1]
期刊: 《中华肿瘤杂志》2020年42卷10期 869-875页 MEDLINEISTICPKUCSCDCABP
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn112152-20190213-00082
发布时间: 2020-11-16
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