腹腔镜根治性全胃切除术治疗老年原发性胃癌患者的倾向评分配比预后分析  

Prognostic factors of laparoscopic radical total gastrectomy for elderly patients with primary gastric cancer using propensity score matching analysis

作　　者：陆俊[1] 黄昌明[1] 郑朝辉[1] 李平[1] 谢建伟[1] 王家镔[1] 林建贤[1] 陈起跃[1] 曹龙龙[1] 林密[1] 涂儒鸿 

机构地区：[1]福建医科大学附属协和医院胃外科,福州350001

出　　处：《中华消化外科杂志》2016年第3期221-227,共7页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设基金，福建省科技计划重点项目(2-14Y0025) National Key Clinical Specialty Discipline Construction Program，Science and Technology Development Key Program of Fujian Province

摘　　要：目的探讨腹腔镜根治性全胃切除术治疗老年原发性胃癌患者的预后及其影响因素。方法采用倾向评分配比及回顾性病例对照研究方法。收集2010年1月至2012年12月福建医科大学附属协和医院收治的338例老年原发性胃癌患者的临床病理资料。行腹腔镜根治性全胃切除术患者246例，行开腹根治性全胃切除术患者92例。采用门诊、家访、信件、电话方式进行随访，了解患者术后生存情况。随访时间截至2015年12月。观察指标包括：（1）患者临床病理资料：性别、年龄、BMI、术前伴发疾病查尔森指数、美国麻醉医师协会（ASA）分级、肿瘤部位、肿瘤直径、淋巴结清扫数量、肿瘤病理学分型、肿瘤pTNM分期。（2）采用倾向评分配比对行腹腔镜和开腹根治性全胃切除术患者进行配对。将配比后行腹腔镜根治性全胃切除术患者设为腹腔镜组，行开腹根治性全胃切除术患者设为开腹组。（3）预后指标：3年累积生存率。（4）预后因素分析指标：性别、肿瘤部位、肿瘤直径、手术方式、肿瘤病理学分型、肿瘤临床分期。（5）对独立预后因素的分层分析。正态分布的计量资料以x±s表示，组间比较采用LSD—t检验和配对t检验。计数资料比较采用χ^2检验。采用Logistic回归模型进行倾向评分配比。采用Kaplan—Meier法绘制生存曲线并计算生存率，Log-rank检验比较生存率。采用COX比例风险模型进行预后单因素和多因素分析。结果338例患者中，共87对患者（腹腔镜组和开腹组患者各87例）完成配对。两组患者年龄、肿瘤pTNM分期由配比前差异有统计学意义（t=-1．692，χ^2=8．437，P〈0．05），经配比后，差异无统计学意义（t=-1．793，χ^2=0．074，P〉0．05）。配比前338例患者中，306例获得随访，随访时间为2～67个月，中位随访时间为32个月。行腹腔镜根治性全胃切除术患者3�Objective To investigate the prognostic factors of laparoscopic radical total gastrectomy for elderly patients with primary gastric cancer. Methods The retrospective case-control study was adopted by using propensity score matching analysis. The clinicopathological data of 338 elderly patients with primary gastric cancer who were admitted to the Union Hospital of Fujian Medical University between January＇ 2010 and December 2012 were collected, including 246 receiving laparoseopic radical total gastrectomy （LTG） and 92 receiving open radical total gastrectomy （OTG）. The follow-up was performed to detect postoperative survival of patients by outpatient examination, home visit, correspondence and telephone interview till December 2015. Observation indicators included： （1） the elinicopathological data： gender, age, body mass index （BMI）, Charlson scores of preoperative concomitant diseases, American Society of Anesthesiologists （ASA） grading, tumor location and diameter, number of lymph node dissected, pathologic classification of tumors and pathologic TNM （pTNM） stage. （2） All the patients were allocated into the LTG group and OTG group after a propensity scare matching analysis. （3） Prognostic indicator included 3-year cumulative survival rate. （4） Prognostic analysis indicators included gender, tumors location and diameter, surgical procedures, pathological classification and tumor clinical staging. （5） Independent prognostic factors were done by the stratification analysis. Measurement data with normal distribution were presented as x±s and comparison between groups was analyzed by LSD-t test and matching t test. Count data were analyzed using the chi-square test. The propensity score matching analysis was done using Logistic regression model. The survival curve was drawn by Kaplan-Meier method and survival rate was calculated using the Log-rank test. The univariate analysis and multivariate analysis were done using the COX proportional risk model. Results Of 338 pat

关 键 词：胃肿瘤 老年 胃切除术 腹腔镜检查 预后 倾向评分配比 

分 类 号：R735.2[医药卫生—肿瘤]