胃癌的脉管侵犯及预后影响因素  

Influencing factors for vascular invasion and prognosis in gastric cancer

作　　者：杨玉杰 黄晓东[1] 杨超[1] 程煌荣 黎华丽 郑勇斌[1] YANG Yujie;HUANG Xiaodong;YANG Chao;CHENG Huangrong;LI Huali;ZHENG Yongbin(Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院

出　　处：《山东医药》2020年第3期21-24,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81372553)

摘　　要：目的分析胃癌的脉管侵犯(LBVI)及预后的影响因素。方法选择2015年6月~2018年6月在武汉大学人民医院行胃癌根治术的患者356例,根据是否发生LBVI分为LBVI阳性者(221例,中位生存时间26个月)、LBVI阴性者(135例,中位生存时间31个月),采用单因素及多因素分析胃癌发生LBVI的影响因素;应用Kaplan-Meier法对LBVI阳性与阴性者绘制生存曲线,Log-rank检验进行比较,采用单因素及多因素COX比例风险回归模型分析预后影响因素。结果单因素分析显示,性别、超敏CRP、CEA、分化程度、肿瘤直径、浸润深度、淋巴结转移、TNM分期是胃癌发生LBVI的影响因素(P均<0.05);多因素分析显示,肿瘤分化不良、直径大、浸润深度深、淋巴结转移及TNM分期晚是胃癌LBVI的危险因素(P均<0. 05)。单因素分析显示,肿瘤分化程度、肿瘤直径、浸润深度、淋巴结转移、TNM分期是胃癌预后的影响因素(P均<0. 05);多因素分析显示,肿瘤分化不良、浸润深度深、淋巴结转移、TNM分期晚、LBVI是胃癌预后的危险因素(P均<0.05)。结论肿瘤分化不良、直径大、浸润深度深、淋巴结转移及TNM分期晚的胃癌更易发生脉管浸润;肿瘤分化不良、浸润深度深、淋巴结转移及TNM分期晚的胃癌预后较差。Objective To investigate the influencing factors of vascular invasion( LBVI) and its effect on the prognosis of gastric cancer. Methods A retrospective analysis was performed for the clinicopathological data of 356 patients with gastric cancer who underwent radical gastrectomy in Renmin Hospital of Wuhan University from June 2015 to June 2018. Based on the occurrence of LBVI,we divided patients into LBVI-positive group( 221 patients with median survival time of 26 months) and LBVI-negative group( 135 patients with median survival time of 31 months). The influencing factors of vascular invasion in gastric cancer were analyzed by univariate and multivariate analysis. Kaplan-Meier method was used to draw survival curves for positive or negative vascular invasion in gastric cancer patients,and Log-rank test was used for comparison.Univariate and multivariate COX proportional hazard regression models were used to analyze the prognosis of gastric cancer patients. Results Univariate analysis of vascular invasion showed that sex,hs-CRP,CEA,tumor differentiation,tumor diameter,depth of deeper tumor invasion,lymph node metastasis and TNM stages were associated with LBVI in gastric carcinoma( all P <0. 05). Multivariate analysis indicated that tumor differentiation,large diameter,deeper tumor invasion,lymph node metastasis and advanced TNM stage were independent risk factors for LBVI in gastric carcinoma( all P < 0. 05). Univariate analysis showed that tumor differentiation,tumor diameter,depth of invasion,lymph node metastasis and TNM stage were associated with the prognosis of gastric cancer( all P < 0. 05). Multivariate analysis showed that tumor differentiation,deeper tumor invasion,lymph node metastasis,advanced TNM stage,and LBVI were independent prognostic factors for gastric cancer( all P < 0. 05). Conclusions Gastric cancer patients with poor tumor differentiation,large diameter,deeper tumor invasion,lymph node metastasis and advanced TNM stage are more prone to LBVI. Gastric cancer patients with poor tumor differe

关 键 词：胃癌 胃肿瘤 脉管侵犯 患者预后 肿瘤分化 肿瘤直径 肿瘤浸润深度 淋巴结转移 TNM分期 

分 类 号：R735.2[医药卫生—肿瘤]