| Objective: To observe the efficacy and safety of multi-line chemotherapy in patients with advanced gastric cancer,and to explore the independent prognostic factors of survival in order to provide more theoretical basis for guiding the choice of back-line therapy in clinical practice.Methods: This present study was a retrospective study to screen patients with advanced gastric cancer who were treated in Liaoning Provincial Tumor Hospital from April 2016 to October 2017.The patients' gender,age,ECOG score,Tumor location and number,pathological differentiation degree,chemotherapy regimen,treatment status and toxicity were analyzed.The Kaplan-Meier survival curves and log-rank test were used to analyze the relationship between these clinicopathological factors and the OS in advanced gastric cancer patients,the COX proportional hazard model was used to analyze the independent prognostic factors affecting survival.Results: A toal of 52 patients with advanced gastric cancer were included in this study.By the end of the study,35(67.9%)patients died.The 52 patients received 321 cycles of chemotherapy,with a median of 6 cycles(1-23).The median OS was 9.3 months(95%CI: 7.43-11.10).The median PFS for first-line treatment was 5.2 months(95% CI:4.32-6.13).The median second-line OS was 4.0 months(95% CI: 2.70-5.26)and the median PFS was 2.6 months(95% CI: 2.24-2.89)in 28 patients(53.8%)receiving second-line and above therapy.In this study,24 patients(46.2%)only received first-line chemotherapy,with a median OS of 6.0 months(95% CI 5.17-6.92),20 patients(38.5%)receiving 1-2 line therapy with a median OS of 10.6 months(95% CI: 8.27-13.02).In 8patients(15.4%)receiving 1-3 line therapy.the median OS was 11.8 months(P = 0.001).The ORR of first-line treatment was 29.4% and DCR was 76.5%.The ORR of second-line chemotherapy was 14.8% and the DCR was 51.9%.The ORR of third line treatment was 0.0%,DCR was 42.9%.Among the first-line chemotherapy regimens,37(71.2%)were combined with two drugs and 12(23.1%)were triple-drug regimens.The median OS was 9.8 months(95% CI: 7.75-11.76)and 8.9 months(95%CI:4.83-13.04)(P=0.961).Median PFS were 5.0 months(95% CI: 4.43-5.63)and 5.7 months(95% CI:4.20-7.24)(P = 0.814).Among the two regimens,28 cases(75.7%)were treated with platinum and fluorouracil,including 16 cases(57.1%)with SOX regimen and 7(18.9%)cases were treated with combined taxane and fluorouracil,including 5 cases(71.4%)with TS regimen.The median OS of the SOX regimen and the TS regimen was 9.0months(95% CI: 6.67-11.40)and 10.0 months(95% CI: 4.59-15.45),respectively(P =0.938).In second-line chemotherapy,22 cases(78.6%)were combined with two drugs.In the combination regimens,11 cases(50.0%)were based on taxanes,while 9 cases(40.9%)were based on irinotecan,and their median OS was 4.3 months(95% CI: 1.78-6.70)and 2.0 months(95% CI: 0.67-3.33)(P = 0.072),respectively.The median PFS was2.6 months(95% CI: 1.71-3.41)and 1.5 months(95% CI: 0.56-2.47)(P = 0.047).In terms of adverse reactions,myelosuppression,fatigue,elevated transaminases and gastrointestinal reactions were the most common reactions in all lines chemotherapy of the AGC.The rare ones included hand-foot syndrome,rash,hair loss,and a small number of patients with granulomatous fever.Most of them were ranked as grade 1/2.Univariate analysis showed that ECOG score,ascites,second-line treatment,first-line treatment PFS> 5.2 months and the number of cycles of chemotherapy>6 cycles were the factors influencing the OS of gastric cancer patients(P <0.05).Multivariate analysis showed that second-line treatment,first-line treatment PFS> 5.2 months is an independent protective factor affecting the survival of patients with advanced gastric cancer.Conclusions: This study demonstrates that first-line chemotherapy for advanced gastric cancer is safe and effective and that multi-line chemotherapy can prolong survival.Multivariate analysis showed that first-line PFS> 5.2 months and second-line treatment were independent predictors of survival in patients with advanced gastric cancer. |
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