| Objective To explore the difference of the curative effect between transcatheter arterial chemoembolization(TACE)in combination with chemotherapy and single chemotherapy in treatment of gastric cancer with liver metastasis.Methods Totally 68 patients with gastric cancer with liver metastasis without surgical indications treated in our institution from Apr.2013 to Apr.2017 were collected.There were male 41 patients and female 27 patients,with age from 42 to72 years and mean age(60.0±13.7)years.Subjects were divided into observation group(n=32)and control group(n=36)according to the wishes of patients and their families.Patients in the control group were treated with single chemotherapy,and patients in the observation group were treated with TACE in combination with chemotherapy.Statistical analysis was performed using SPSS 19.0 software.Clinical baseline data,short term effect,and incidence of adverse reactions in the two groups were compared with Chi-squared test.Survival rate in the two groups were compared with Log rank test.KPS score before and after treatments in the two groups were compared with independent-samples t test.Simple factor andmulti-factors analysis of prognosis for observation group were used by Kaplan-Meier test and Cox regression model,respectively.Results Theshort-term efficacy rates of the control group and observation group were 33.3% and 62.5% respectively.The difference of short-term efficacy between the two groups was statistically significant(c2=5.785,P=0.016).The main toxic and side effects in the two groups included nausea,emesis,stomatitis,transaminase elevation,and myelosuppression.The differences of incidences rate of toxic and side effects between the two groups were all not statistically significant(P>0.05).Such severe adverse reactions as treatment-related death,hepatic failure,renal failure,fever and infection due to granulocytopenia were not happened in the two groups.Postembolization syndrome such as hepatalgia and fever happened among twenty-one(65.6%)patients in the control group,and relieved after3 ~ 5 days symptomatic treatments.There were eight(22.2%)patients in the control happened with Ⅲ ~ Ⅳ level toxic and side effect,and nine(28.1%)patients in the control group(c 2=0.315,P=0.575).All patients were not lost during the follow-up.Five patients survived at the final follow-up,including three patients inthe control group and two patients inthe observation group.The follow-up period was from 2 to 48 months,with median follow-up time 13 months.The 0.5,1,2,and 3 year accumulate survival rate of control group and observation group were 66.6%,48.7%,19.8%,0% and 84.4%,62.5%,28.1%,15.6%,respectively.The median survival time of control group and observation group were12 months and 13 months,respectively.The difference of overall survival between the two groups was statistically significant(c 2=4.455,P=0.035).The difference of KPS score between the two groups before treatment was not statistically significant(P > 0.05).The difference of KPS score between the two groups six months after treatment was statistically significant(P<0.05).Simple factor analysis displayed that degree of tumor differentiation,albumin,and degree of liver metastasis were related to prognosis(P<0.05).However,age,sex,position of gastric cancer,CEA,AFP,and CA199 were not related to prognosis(P>0.05).Multi-factors analysis showed that degree of tumor differentiation and degree of liver metastasis were independent influencing factors for prognosis(P<0.05).Conclusion TACE in combination with chemotherapy is better than the single chemotherapy in treatment of gastric cancer with liver metastasis.It can improve the short term effect,life cycle,and living quality,without increase of the incidences of toxic side effects simultaneously,and and is worthy of further clinical discussion. |
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