早期胃癌患者脉管浸润的危险因素分析  

Analysis of risk factors on vascular invasion in patients with early gastric cancer

作　　者：韦之见[1] 徐阿曼[1] 韩文秀[1] 陈章明[1] Wei Zhijian;Xu Aman;Hart Wenxiu;Chen Zhangming(Department of Gastrointestinal Surgery, The First Affiliated Hospital, Anhui Medical University, Hefei 230022, Chin)

机构地区：[1]安徽医科大学第一附属医院胃肠外科,合肥230022

出　　处：《中华胃肠外科杂志》2018年第7期803-807,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81572350）

摘　　要：目的探讨早期胃癌患者出现脉管浸润的危险因素以及脉管浸润对早期胃癌生存预后的影响。方法安徽医科大学第一附属医院2014年1月至2015年12月期间，收治并行手术治疗的早期胃癌患者449例，其中有27例（6.0%）发生脉管浸润。对这组早期胃癌病例的临床病理资料进行回顾性病例对照研究。采用χ^2验或Fisher确切概率法对脉管浸润与早期胃癌患者的临床病理特征进行单因素分析；采用logistic多因素回归模型分析脉管浸润的独立危险因素；采用Kaplan-Meier法分析脉管浸润对早期胃癌患者生存预后的影响。本研究经医院伦理委员会讨论备案（快2018-03-12）。结果449例患者中，男325例，女124例，男女比例2.6∶1.0；年龄27-87（60.8±10.5）岁；T1a期228例，T1b期221例。单因素分析结果显示，449例早期胃癌患者中，溃疡型或溃疡瘢痕型者其脉管浸润率为8.4%（18/215），高于非溃疡型者的3.8%（9/234），差异有统计学意义（χ^2=4.061，P=0.044）；低分化型者脉管浸润率为8.8%（20/226），高于中-高分化型患者的3.1%（7/223），差异也有统计学意义（χ^2=8.363，P=0.012）；T1b期患者脉管浸润率为10.9%（24/221），高于T1a期的1.3%（3/228），差异有统计学意义（P=0.000）；有淋巴结转移者脉管浸润率为27.3%（15/55），高于无淋巴结转移者的3.0%（12/394），差异亦有统计学意义（χ^2=50.122，P=0.000）；而患者性别、年龄、手术方式、肿瘤是否多发、有无癌结节、肿瘤部位和肿瘤长径与早期胃癌患者脉管浸润无关（均P〉0.05）。多因素分析结果显示，肿瘤浸润至黏膜下层（RR=4.653，95%CI：1.293-16.747，P=0.019）和淋巴结转移阳性（RR=7.302，95%CI：3.063-17.408，P=0.000）是早期胃癌患者脉管浸润的独立危险因素。全组449例患者获得完整随访者444例（98.9%），其中脉管浸润组26例，非脉管浸润组418例。发�Objective To explore the risk factors of vascular invasion in patients with early gastric cancer （EGC）, and to investigate the influence of vascular invasion on the prognosis of EGC patients. Methods From January 2014 to December 2015, 449 EGC patients underwent curative gastrectomy at the First Affiliated Hospital of Anhui Medical University, of whom 27 cases （6.0%） developed vascular invasion. Clinicopathologieal and follow-up data of EGC cases were analyzed retrospectively. The association between clinicopathological features and vascular invasion was analyzed by using the Chi-square test or Fisher exact test, and the independent risk factors influencing vascular invasion were identified with logistic regression. The influence of vascular invasion on overall survival was investigated with Kaplan-Meier curve. This study was approved by Ethics Committee of The First Affiliated Hospital of Anhui Medical University （No. 2018-03-12）. Results Of 449 EGC patients, 325 were males and 124 were females （ratio 2.6： 1.0） with the mean age of （60.8±10.5） （27 to 87） years; 228 were diagnosed as Tla stage and 221 were diagnosed as Tlb. Univariate analysis showed that incidence of vascular invasion in EGC patients with ulceration or scar was 8.4%（18/225）, which was higher than 3.8% （9/234） in those without ulceration, and the difference was statistically significant （χ^2=4.061, P=0.044）. The incidence of vascular invasion in patients with low differentiated tumor was 8.8% （20/226）, which was significantly higher than 3.1% （7/223） in those with middle-high differentiated tumor （χ^2= 8.363, P=0.012）. The incidence of vascular invasion in patients staging Tlb was 10.9% （24/221）, which was significantly higher than 1.3% （3/228） in those staging Tla （P= 0.000）; The incidence of vascular invasion in patients with lymph node metastasis was 27.3% （15/ 55）, which was significantly higher than 3.0%（12/394） in those without lymph node metastasis （χ^2= 50.122, P=

关 键 词：胃肿瘤 早期 脉管浸润 危险因素 预后 

分 类 号：R735.2[医药卫生—肿瘤]