神经浸润对1801例胃癌术后预后的影响  

Effect of perineural invasion in prognosis of 1 801 patients undergoing radical resection of gastric cancer

作　　者：陈路川[1] 魏晟宏[1] 叶再生[1] 林振孟 陈小玲[1] 曾奕[1] 王益[1] 李阳明[1] 肖军[1] 

机构地区：[1]福建医科大学附属肿瘤医院胃肠肿瘤外科,福州350014

出　　处：《中华消化外科杂志》2017年第3期262-268,共7页Chinese Journal of Digestive Surgery

基　　金：福建省青年科研课题（2014-2-8）

摘　　要：目的：探讨神经浸润与胃癌临床病理因素及预后的关系。方法：采用回顾性病例对照研究方法。收集1999年3月至2015年11月福建医科大学附属肿瘤医院收治的1 801例胃癌患者的临床病理资料。患者行手术治疗以尽可能达到根治性切除目的，切除全胃或2/3以上胃及D2淋巴结清扫术。术前临床分期为Ⅲ期患者接受新辅助化疗。术后病理学分期为T3～T4期、淋巴结阳性的T1～T2期，以及具有高危因素（肿瘤低分化、脉管浸润、神经浸润、年龄〈50岁）的T2N0期患者予以术后化疗。观察指标：（1）治疗情况。（2）病理学特征。（3）随访结果。（4）影响患者预后的因素。通过门诊、电话进行随访。术后第 1个月随访；术后2年内每3个月随访1次；术后3～5年，每6个月随访1次；随访项目包括问诊、体格检查、血常规、生化检查、CEA、CA199、彩色多普勒超声或CT、内镜检查等。随访时间截至2016年2月。正态分布的计量资料采用±s表示，组间比较采用t检验；偏态分布的计量资料采用M（范围）表示。等级资料比较采用非参数检验。单因素和多因素分析采用COX回归模型，并计算HR和95%可信区间。采用 KaplanMeier法绘制生存曲线，Logrank检验进行生存分析。结果：（1）治疗情况：1 801例胃癌患者均行传统开腹手术，其中1 570例行根治性手术，231例行姑息性手术。1 029例患者行全胃切除术，540例行远端胃切除术，201例行扩大切除术，31例行残胃切除术。1 801例患者手术时间为（173±40）min，术中出血量为（224±91）mL，清扫淋巴结数目为（30±13）枚，术后住院时间为（15±9）d。1 801例胃癌患者中，79例行术前新辅助化疗，906例行术后辅助化疗。（2）病理学特征：1 801例胃癌患者术后病理学检查结果显示： 509例神经浸润阳性，1 292例神经浸润阴性。神经浸润阳性胃癌患者的�Objective：To investigate the relationship between perineural invasion and clinicopathological factors of gastric cancer or prognosis of patients. Methods：The retrospective casecontrol study was conducted. The clinicopathological data of 1 801 patients with gastric cancer who were admitted to the Affiliated Tumor Hospital of Fujian Medical University between March 1999 and November 2015 were collected. All the patients received surgery in order to the radical resection of gastric cancer, and total gastrectomy or twothirds and above of gastrectomy and D2 lymph node dissection were performed. Patients with preoperative stage III of clinical staging underwent neoadjuvant chemotherapy. Patients with T3-T4 of histopathologic stage, T1-T2 of positive lymph nodes and T2N0 of high risk factors （low differentiated tumor, lymphovascular invasion, perineural invasion and age 〈50 years） underwent postoperative chemotherapy. Observation indicators： （1） treatment situations; （2） pathological characteristics; （3） followup results; （4） prognostic factors. Followup using outpatient examination and telephone interview was performed once within 1 month postoperatively, once every 3 months within 2 years postoperatively and once every 6 months from 3 to 5 years postoperatively up to February 2016. Followup included inquiry, physical examination, routine blood test, biochemical test, carcinoembryonic antigen （CEA）, CA199, color Doppler ultrasound or computed tomography （CT） and endoscopy. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M （range）. Ordinal data was analyzed by the nonparametric test. The univariate analysis and multivariate analysis were done using the COX regression model. The hazard ratio （HR） and 95% confidence interval （CI） were calculated. The survival curve and survival analysis were respectively drawn and done by the KaplanMeier

关 键 词：胃肿瘤 神经浸润 预后 

分 类 号：R735.2[医药卫生—肿瘤]