腹腔和盆腔肿瘤导致恶性肠梗阻的预后因素分析
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摘要
目的探讨影响腹腔和盆腔肿瘤合并恶性肠梗阻患者的预后因素。方法选取2008年8月—2017年8月因腹腔和盆腔肿瘤导致恶性肠梗阻就诊的患者76例,记录其人口学、临床特点、实验室检查、影像学检查、本次和既往治疗方式等资料。通过电话随访患者生存期,随访截至2018年1月1日。单因素生存分析采用Kaplan-Meier生存曲线,多因素分析采用COX比例风险回归模型。结果单因素分析发现,性别、年龄、原发肿瘤部位、有无远处转移、原发灶行腹腔或盆腔手术、放射治疗和确诊恶性肠梗阻后是否行化学治疗与患者的预后均无关(P值均>0.05)。将是否合并腹水、血红蛋白≤90 g/L和血清白蛋白≤35 g/L纳入多因素分析(P值均<0.2)。多因素分析发现,合并腹水[风险比(HR)=2.019,95%CI为1.103～3.695,P=0.023]和血清白蛋白水平(HR=1.780,95%CI为1.016～3.119,P=0.044]为影响恶性肠梗阻患者预后的独立危险因素。结论合并腹水和血清白蛋白≤35 g/L是影响腹腔和盆腔肿瘤导致恶性肠梗阻预后不良的独立危险因素。积极的抗肿瘤治疗模式可能并不会延长恶性肠梗阻患者的生存期。
Objective To investigate the prognostic factors of patients with malignant bowel obstruction(MBO) caused by abdominal tumors. Methods A total of 76 patients with abdominal tumors combined with malignant bowel obstruction were enrolled in this study. Demographics, clinical features, laboratory, radiographic examinations and treatment model were analyzed. Follow-up was completed until January 1 st, 2018. Survival was estimated using Kaplan-Meier plots and COX regression models were used to evaluate prognostic factors for survival. Results Gender, age, primary malignancy, presence of distant organ metastasis, prior operation or radiotherapy and post-incident treatment model(chemotherapy vs supportive care only) were independent of patient survival(all P>0.05). Ascites, hemoglobin(≤90 g/L) and serum albumin(≤35 g/L) were brought into multivariate analysis(all P<0.2). The result showed that only ascites(harzard ratio [HR]=2.019, 95% credibility interval [95%CI]: 1.103-3.695, P=0.023) and serum albumin level(HR=1.780, 95%CI: 1.016-3.119, P=0.044) were the independent prognostic indicators of MBO. Conclusion Ascites and serum albumin≤35 g/L are the independent prognostic indicators of MBO in patients with abdominal tumors. MBO patients can not benefit from active anti-tumor treatment.(Shanghai Med J, 2019, 42: 203-207)
Objective To investigate the prognostic factors of patients with malignant bowel obstruction(MBO) caused by abdominal tumors. Methods A total of 76 patients with abdominal tumors combined with malignant bowel obstruction were enrolled in this study. Demographics, clinical features, laboratory, radiographic examinations and treatment model were analyzed. Follow-up was completed until January 1 st, 2018. Survival was estimated using Kaplan-Meier plots and COX regression models were used to evaluate prognostic factors for survival. Results Gender, age, primary malignancy, presence of distant organ metastasis, prior operation or radiotherapy and post-incident treatment model(chemotherapy vs supportive care only) were independent of patient survival(all P>0.05). Ascites, hemoglobin(≤90 g/L) and serum albumin(≤35 g/L) were brought into multivariate analysis(all P<0.2). The result showed that only ascites(harzard ratio [HR]=2.019, 95% credibility interval [95%CI]: 1.103-3.695, P=0.023) and serum albumin level(HR=1.780, 95%CI: 1.016-3.119, P=0.044) were the independent prognostic indicators of MBO. Conclusion Ascites and serum albumin≤35 g/L are the independent prognostic indicators of MBO in patients with abdominal tumors. MBO patients can not benefit from active anti-tumor treatment.(Shanghai Med J, 2019, 42: 203-207)
引文
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[6]林泳,何媛,赵晶,等.27年间77 978例结肠镜下结直肠息肉和结直肠癌临床病理特征及变化趋势[J].中华消化杂志,2019,39(2):106-110.
[7]ROSE P G,PIVER M S,TSUKADA Y,et al.Metastatic patterns in histologic variants of ovarian cancer:an autopsy study[J].Cancer,1989,64(7):1508-1513.
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[11]CHAKRABORTY A,SELBY D,GARDINER K,et al.Malignant bowel obstruction:natural history of a heterogeneous patient population followed prospectively over two years[J].J Pain Symptom Manage,2011,41(2):412-420.
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[13]张岂凡,郑宏群,孙凌宇.胃癌腹腔转移所致恶性肠梗阻的诊治及营养支持策略[J].中国肿瘤临床,2014,41(12):749-752.
[14]HENRY J C,POULY S,SULLIVAN R,et al.A scoring system for the prognosis and treatment of malignant bowel obstruction[J].Surgery,2012,152(4):747-757.
[15]AMIKURA K,SAKAMOTO H,YATSUOKA T,et al.Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma[J].J Surg Oncol,2010,101(3):228-232.
[16]DALAL K M,GOLLUB M J,MINER T J,et al.Management of patients with malignant bowel obstruction and stageⅣcolorectal cancer[J].J Palliat Med,2011,14(7):822-828.
[17]CHOUHAN J,GUPTA R,ENSOR J,et al.Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction[J].Cancer Med,2016,5(2):239-247.
[18]YANG S,LI S,YU H,et al.Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer[J].Curr Oncol,2016,23(3):e248-e252.
[19]BARNI S,CABIDDU M,GHILARDI M,et al.A novel perspective for an orphan problem:old and new drugs for the medical management of malignant ascites[J].Crit Rev Oncol Hematol,2011,79(2):144-153.
[20]王阿曼,宁振,周涛,等.晚期肿瘤合并恶性肠梗阻的预后分析[J].现代肿瘤医学,2014,22(2):379-383.
[21]CHANG D K,KIM J W,KIM B K,et al.Clinical significance of CT-defined minimal ascites in patients with gastric cancer[J].World J Gastroenterol,2005,11(42):6587-6592.
[22]MAEDA H,KOBAYASHI M,SAKAMOTO J.Evaluation and treatment of malignant ascites secondary to gastric cancer[J].World J Gastroenterol,2015,21(39):10936-10947.
[23]STUKAN M.Drainage of malignant ascites:patient selection and perspectives[J].Cancer Manag Res,2017,9:115-130.
[24]SMITH E M,JAYSON G C.The current and future management of malignant ascites[J].Clin Oncol(R Coll Radiol),2003,15(2):59-72.
[25]KITAYAMA J,ISHIGAMI H,KAISAKI S,et al.Weekly intravenous and intraperitoneal paclitaxel combined with S-1for malignant ascites due to advanced gastric cancer[J].Oncology,2010,78(1):40-46.
[26]WRIGHT F C,CHAKRABORTY A,HELYER L,et al.Predictors of survival in patients with non-curative stageⅣcancer and malignant bowel obstruction[J].J Surg Oncol,2010,101(5):425-429.
[27]MEDINA-FRANCO H,GARCA-ALVAREZ M N,ORTIZ-LPEZ L J,et al.Predictors of adverse surgical outcome in the management of malignant bowel obstruction[J].Rev Invest Clin,2008,60(3):212-216.
[28]LIEN Y C,HSIEH C C,WU Y C,et al.Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia[J].J Gastrointest Surg,2004,8(8):1041-1048.
[29]VINCENT J L,NAVICKIS R J,WILKES M M.Morbidity in hospitalized patients receiving human albumin:a metaanalysis of randomized,controlled trials[J].Crit Care Med,2004,32(10):2029-2038.
[2]CHAKRABORTY A,SELBY D,GARDINER K,et al.Malignant bowel obstruction:natural history of a heterogeneous patient population followed prospectively over two years[J].J Pain Symptom Manage,2011,41(2):412-420.
[3]于世英,王杰军,王金万,等.晚期癌症患者合并肠梗阻治疗的专家共识[J].中华肿瘤杂志,2007,29(8):637-640.
[4]YONEMURA Y,BANDOU E,KAWAMURA T,et al.Quantitative prognostic indicators of peritoneal dissemination of gastric cancer[J].Eur J Surg Oncol,2006,32(6):602-606.
[5]KOPPE M J,BOERMAN O C,OYEN W J,et al.Peritoneal carcinomatosis of colorectal origin:incidence and current treatment strategies[J].Ann Surg,2006,243(2):212-222.
[6]林泳,何媛,赵晶,等.27年间77 978例结肠镜下结直肠息肉和结直肠癌临床病理特征及变化趋势[J].中华消化杂志,2019,39(2):106-110.
[7]ROSE P G,PIVER M S,TSUKADA Y,et al.Metastatic patterns in histologic variants of ovarian cancer:an autopsy study[J].Cancer,1989,64(7):1508-1513.
[8]张小龙,高枫.腹腔恶性肿瘤的种植转移[J].结直肠肛门外科,2013,19(3):194-196.
[9]SELBY D,WRIGHT F,STILOS K,et al.Room for improvement?A quality-of-life assessment in patients with malignant bowel obstruction[J].Palliat Med,2010,24(1):38-45.
[10]MIRENSKY T L,SCHUSTER K M,ALI U A,et al.Outcomes of small bowel obstruction in patients with previous gynecologic malignancies[J].Am J Surg,2012,203(4):472-479.
[11]CHAKRABORTY A,SELBY D,GARDINER K,et al.Malignant bowel obstruction:natural history of a heterogeneous patient population followed prospectively over two years[J].J Pain Symptom Manage,2011,41(2):412-420.
[12]BAINES M,OLIVER D J,CARTER R L.Medical management of intestinal obstruction in patients with advanced malignant disease:a clinical and pathological study[J].Lancet,1985,2(8462):990-993.
[13]张岂凡,郑宏群,孙凌宇.胃癌腹腔转移所致恶性肠梗阻的诊治及营养支持策略[J].中国肿瘤临床,2014,41(12):749-752.
[14]HENRY J C,POULY S,SULLIVAN R,et al.A scoring system for the prognosis and treatment of malignant bowel obstruction[J].Surgery,2012,152(4):747-757.
[15]AMIKURA K,SAKAMOTO H,YATSUOKA T,et al.Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma[J].J Surg Oncol,2010,101(3):228-232.
[16]DALAL K M,GOLLUB M J,MINER T J,et al.Management of patients with malignant bowel obstruction and stageⅣcolorectal cancer[J].J Palliat Med,2011,14(7):822-828.
[17]CHOUHAN J,GUPTA R,ENSOR J,et al.Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction[J].Cancer Med,2016,5(2):239-247.
[18]YANG S,LI S,YU H,et al.Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer[J].Curr Oncol,2016,23(3):e248-e252.
[19]BARNI S,CABIDDU M,GHILARDI M,et al.A novel perspective for an orphan problem:old and new drugs for the medical management of malignant ascites[J].Crit Rev Oncol Hematol,2011,79(2):144-153.
[20]王阿曼,宁振,周涛,等.晚期肿瘤合并恶性肠梗阻的预后分析[J].现代肿瘤医学,2014,22(2):379-383.
[21]CHANG D K,KIM J W,KIM B K,et al.Clinical significance of CT-defined minimal ascites in patients with gastric cancer[J].World J Gastroenterol,2005,11(42):6587-6592.
[22]MAEDA H,KOBAYASHI M,SAKAMOTO J.Evaluation and treatment of malignant ascites secondary to gastric cancer[J].World J Gastroenterol,2015,21(39):10936-10947.
[23]STUKAN M.Drainage of malignant ascites:patient selection and perspectives[J].Cancer Manag Res,2017,9:115-130.
[24]SMITH E M,JAYSON G C.The current and future management of malignant ascites[J].Clin Oncol(R Coll Radiol),2003,15(2):59-72.
[25]KITAYAMA J,ISHIGAMI H,KAISAKI S,et al.Weekly intravenous and intraperitoneal paclitaxel combined with S-1for malignant ascites due to advanced gastric cancer[J].Oncology,2010,78(1):40-46.
[26]WRIGHT F C,CHAKRABORTY A,HELYER L,et al.Predictors of survival in patients with non-curative stageⅣcancer and malignant bowel obstruction[J].J Surg Oncol,2010,101(5):425-429.
[27]MEDINA-FRANCO H,GARCA-ALVAREZ M N,ORTIZ-LPEZ L J,et al.Predictors of adverse surgical outcome in the management of malignant bowel obstruction[J].Rev Invest Clin,2008,60(3):212-216.
[28]LIEN Y C,HSIEH C C,WU Y C,et al.Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia[J].J Gastrointest Surg,2004,8(8):1041-1048.
[29]VINCENT J L,NAVICKIS R J,WILKES M M.Morbidity in hospitalized patients receiving human albumin:a metaanalysis of randomized,controlled trials[J].Crit Care Med,2004,32(10):2029-2038.