5-FU 之合併化療於進展性胃癌病人之毒性與預後因子探討
Determination of the Prognosis Factors and Risk Factors of Toxicity for Advanced Gastric Cancer Patients Treated by 5-FU-Based Chemotherapy
中文摘要
近年來全球癌症人口不斷上升，其中胃癌之罹病率和致死率仍高居世界第二位，如此高之致死 率，主要的原因之一為早期診斷率太低，因此大多數發現罹患胃癌時，已經是進展期胃癌 (advanced gastric cancer)。對於進展期的患者，化學治療是主要的治療方式，然而化療所 產生之毒性作用，往往使得患者無法耐受導致治療的延遲或中斷，因而無法達到治療成效。有 關化療毒性與危險因子之關聯性尚未完全確立，此外對於影響進展性胃癌存活之危險因子仍具 爭議，因此有必要進一步釐清相關之危險因子，以提供臨床醫療人員做為評估治療的參考。
本研究藉由回溯臨床實例的方式，蒐集自民國87 年 1 月到 92 年 12 月，於三家區域醫院診斷 為胃癌，並接受全身性化學治療的病患共65 例，在毒性資料的分析部分，記錄所發生之化療 毒性反應，經由NCI-CTCAE(National Cancer Institute-Common Terminology Criteria for Adverse Events)之評斷準則，分析大於或等於 3 級之嚴重毒性與相關資料的關聯性。結果 顯示在單一變項分析，嚴重之神經毒性與活動力狀態小於60(p=0.028)相關；嚴重之口腔潰 瘍毒性(mucotitis)與年齡高於 64 歲(p=0.026)、曾經接受其他化學治療(p=0.006)具有統計 上相關；患者發生任何嚴重之毒性反應與女性(p=0.038)、活動力狀態小於 80(p=0.043)、化 療期間體重減輕(p=0.04)具有統計上相關；對於發生大於或等於 2 級之口腔潰瘍毒性相關之顯 著因子包括曾經接受化學治療(p=0.024)、baseline WBC < 4000/μL(p=0.009)和 CCr <
70 ml/min (p=0.019)。
在預後分析部分，分析存活與病患相關因素、腫瘤相關因素、治療相關因素、臨床相關因素之結 果顯示，胃癌患者無法以手術切除(p=0.022) 及發生腹水併發症(p=0.026)的預後較差，具 統計顯著相關。
本研究藉由化療毒性與預後相關性探討，提供醫療人員對高危險群之加強監測，而能夠避免或 降低毒性發生的嚴重度。
英文摘要
Data due to food processing, the incidence and mortality rates for gastric cancer have decreased markedly during the past 60 years; gastric cancer is still the second leading cause of cancer death worldwide. The majority of the patients were found to have advanced disease at the time of diagnosis. For decades, fluorouracil has been the main anticancer drug of the treatment of advanced gastric cancer. Toxicity, however, frequently necessitates decreasing the dosage, extending the dose interval or even discontinuing treatment. Risk factors with predictive value for toxicity have been identified in several studies. In our study, primary end point is to identify the risk factors of severe chemotherapeutic toxicities in patients of advanced gastric cancer. The prognosis of gastric cancer
patients is poor because the majority of the patients were found to have advanced disease at the time of diagnosis. The secondary end point was the prognostic factors of these 5-FU-based chemotherapy treated patients.
These advanced gastric patients who received with 5-fluoruracil-based chemotherapy were included in our study. The results were analyzed
retrospectively. From January 1998 through December 2003, 65 patients were eligible. In the univariate analysis, severe neurotoxicity risk factors were karnofsky performance status(KPS) <60(p=0.028); risk factors for severe mucotitis were age>64 years old(p=0.026), pretreatment chemotherapy(p=0.006); any severe toxicities risk factors were female (p=0.038), KPS <80(p=0.043), weight loss during treatment(p=0.04); ≥grade 2 mucotits risk factors were pretreatment chemotherapy (p=0.024), baseline WBC<4000(p=0.009), CCr<70
(p=0.019)ml/min. In the analysis of prognostic factors of these patients, all factor included patients-related factors, treatment-related factors, tumor-related factors and clinical-related factors, unresectable (p=0.022) and ascites complication (p=0.026)were the independent risk factors by the method of Cox regression
