中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (01): 89-97.DOI: 10.19538/j.cjps.issn1005-2208.2024.01.15

• 论著 • 上一篇    下一篇

基于真实世界数据的胃癌肝转移全国多中心回顾性队列研究（RECORD研究）年度报告

高云鹤1 ，郗洪庆1 ，商    亮2 ，唐兆庆3 ，余    江4，卫    勃1 ，唐    云1 ，乔    治1 ，等   

  1. 1 中国人民解放军总医院第一医学中心普通外科医学部，北京100853；2 山东第一医科大学附属省立医院胃肠外科，山东济南250021；3复旦大学附属中山医院普通外科，上海 200032；4 南方医科大学南方医院普通外科，广东广州510515；5 北京大学肿瘤医院胃肠外科，北京100142 ；6 上海交通大学医学院附属瑞金医院普通外科，上海200025；7天津医科大学肿瘤医院胃部肿瘤科，天津300060；8福建医科大学附属协和医院胃外科，福建福州350001；9复旦大学附属肿瘤医院胃外科，上海200032；10中国医学科学院肿瘤医院胰胃外科，北京100021
  • 出版日期:2024-01-01 发布日期:2024-02-23

  • Online:2024-01-01 Published:2024-02-23

摘要： 目的    研究真实世界条件下，中国多地区多中心胃癌肝转移病人总体临床病理特征、诊疗措施、临床分型及预后情况。方法    回顾性收集自2010年1月1日至2019年12月31日期间中国人民解放军总医院第一医学中心等10家胃癌专科诊疗中心收治的胃癌肝转移病人的真实世界病例资料。病例纳入标准：（1）18周岁≤年龄≤80周岁；（2）胃原发灶肿瘤经活检或手术病理检查结果证实为胃腺癌，肝转移灶经影像学检查提示或活检病理检查结果证实；（3）2010年1月1日至2019年12月31日期间的住院治疗病人。排除标准：（1）发病时或发病前5年内合并其他肿瘤病人；（2）美国东部肿瘤协作组（Eastern Cooperative oncology Group，ECOG）评分>3分或预期寿命＜1个月病人；（3）无随访数据或临床资料严重缺失者。结果    最终1901例符合入排标准的胃癌肝转移病人纳入本研究，胃癌肝转移中国专家共识分型（Chinese consensus classification for gastric cancer liver metastasis，C-GCLM）Ⅰ型（初始可切除型）病人368例（19.4%），Ⅱ型（潜在可切除型）病人475例（25.0%），Ⅲ型（初始不可切除型）病人1058例（55.6%）。入组病人的中位年龄为62（54~68岁）岁，其中男性病人居多，为1562例（82.2%），同时性肝转移1512例（80.1%）。胃原发灶中，肿瘤位于远端胃（36.7%）者略高于胃体（24.1%）及近端胃（29.3%）；肝脏转移灶中以弥漫多发肝转移多见（60.4%），但右肝转移（20.5%）比例略高于左肝（15.4%）。RECORD研究中胃癌肝转移病人总体1年、3年生存率分别为42.0%和16.4%。C-GCLM Ⅰ型、Ⅱ型、Ⅲ型胃癌肝转移病人的3年总体生存率分别为33.0%、24.5%和6.4%，三组病人的总体生存率差异存在统计学意义（P<0.001）。多因素生存分析结果提示，C-GCLM分型为可能影响病人预后的独立危险因素（Ⅲ型vs. Ⅰ型，HR=2.35，95% CI 2.00-2.76，P<0.001；Ⅱ型 vs. Ⅰ型，HR=1.29，95% CI 1.07-1.54，P=0.006）。结论    中国胃癌肝转移病人就诊时以初始不可切除型病人（C-GCLM Ⅲ型）居多；化疗仍是胃癌肝转移病人治疗的基础和主要手段，胃和肝脏转移灶的根治性手术在初始可切除型（C-GCLM Ⅰ型）和潜在可切除型（C-GCLM Ⅱ型）病人中居多。胃癌肝转移中国分型C-GCLM系统对不同型胃癌肝转移病人的预后有较好的区分价值。

关键词: 胃癌, 肝转移, 胃癌肝转移中国专家共识分型（C-GCLM）系统, 临床病理特征, 总体生存率

Abstract: Annual report of a multi-centered retrospective cohort study of treatment and prognosis of gastric cancer liver metastasis based on real-world data        GAO Yun-he*, XI Hong-qing, SHANG Liang, et al.*Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
GAO Yun-he, XI Hong-qing, SHANG Liang, TANG Zhao-qing, YU Jiang are the first authors who contributed equally to this article
Corresponding authors: CHEN Lin, E-mail: chenlinbj@sina.com; LI Le-ping, E-mail: lileping@medmail.com.cn;  SUN Yi-hong，E-mail: sun.yihong@zs-hospital.sh.cn；LI Zi-yu, E-mail: ziyu_li@hsc.pku.edu.cn
Abstract    Objective    To explore and describe the global clinicopathological features, treatment, clinical classification and prognosis of patients with gastric cancer liver metastasis across China under real-world condition. Methods    A retrospectively-established database was built to collect real-world gastric cancer liver metastasis (GCLM) cases from 10 gastric cancer comprehensive treatment institutions including Chinese PLA General Hospital, Shandong Provincial Hospital Affiliated to Shandong First Medical University, etc. The inclusion criteria of this study were as follows: (1) aged from 18- and 80-year old; (2) patients diagnosed with gastric cancer by endoscopic biopsy or surgical pathology; hepatic metastases indicated by imaging or biopsy; (3) in-hospital patients between January 2010 and December 2019. The exclusion criteria were: (1) cases diagnosed with other neoplasms simultaneously or in the previous 5 years; (2) cases with poor performance score (ECOG>3) or life expectance less than 1 month; (3) cases with insufficient data for analysis.Results    Finally, 1901 patients diagnosed with gastric cancer liver metastasis were included in this study with initially unresectable (type Ⅲ) patients accounting for more than half of the total population (type Ⅰ: 368 patients, 19.4%; type Ⅱ: 475 patients, 25.0%; type Ⅲ: 1058 patients, 55.6%). Most patients were male (82.2%) and the median age was 62 years [interquartile range (IQR) 54-68]. Synchronic liver metastasis accounted for the vast majority population (1512 cases, 80.1%). The most frequent primary location of tumor was the distal stomach (36.7%) compared with the proximal (29.3%) and middle stomach (24.1%). Moreover, the right hepatic lobe (20.5%) appeared to be a more vulnerable metastatic target compared with the left lobe (15.4%), while dispersed metastasis in all lobes (60.4%) was the main pattern. In general, the 1- and 3-year overall survival (OS) of gastric cancer patients with liver metastasis was 42.0% and 16.4%, respectively. And the 3-year OS of type Ⅰ, Ⅱ, and Ⅲ patients was 33.0%, 24.5%, and 6.4%, respectively. Distinct survival differences were observed among the three groups (Log-rank test, P<0.001). Multivariate Cox analysis demonstrated that the C-GCLM classification was an independent risk factor for prognosis (Type Ⅲ vs. Ⅰ, HR=2.35, 95% CI 2.00-2.76, P<0.001; type Ⅱ vs. Ⅰ, HR=1.29, 95% CI 1.07-1.54, P=0.006). Conclusion    At the time of the first diagnosis, the initially unresectable patients (C-GCLM Ⅲ) accounted for the majority of total patients with gastric cancer liver metastasis in China. Chemotherapy remains the cornerstone of systemic treatment model for patients with GCLM. The surgical interventions were more applied in initially resectable (type I) and potentially resectable (type Ⅱ) C-GCLM patients. The Chinese consensus classification system of gastric cancer liver metastasis (C-GCLM) demonstrated excellent prognostic discrimination value, which may promote individualized therapy for such patients. 

Key words: gastric cancer, liver metastasis, C-GCLM classification system, clinicopathological features, overall survival