基于SEER数据库分析老年胃癌患者内镜手术与传统术式的治疗效果及预后  

Analysis of the therapeutic effect and prognosis of endoscopic surgery and traditional surgery in elderly patients with gastric cancer based on SEER database

作　　者：万秀萍[1] 翁慧斌[1] 林小花 刘媛[1] 陈大军 林海[1] 陈毓[1] 丁小云[2] Xiu-ping Wan;Hui-bin Weng;Xiao-hua Lin;Yuan Liu;Da-jun Chen;Hai Lin;Yu Chen;Xiao-yun Ding(Department of Gastroenterology,Quzhou People’s Hospital,Quzhou,Zhejiang 324000,China;Department of Gastroenterology,the First Hospital,Ningbo,Zhejiang 315010,China)

机构地区：[1]衢州市人民医院消化内科,浙江衢州324000 [2]宁波市第一医院消化内科,浙江宁波315010

出　　处：《中国内镜杂志》2020年第5期7-14,共8页China Journal of Endoscopy

基　　金：2018年浙江省医药卫生科技计划项目(No:2018ZH025)。

摘　　要：目的基于SEER数据库分析老年胃癌(GC)患者内镜黏膜下剥离术(ESD)与传统术式的治疗效果及预后的影响因素。方法筛选2014年1月-2014年12月SEER数据库登记的ESD或传统术式治疗的老年T1期原发性GC患者,共865例。分析ESD与传统术式的手术效果,并分析预后的影响因素。结果865例患者男女比例为1.00∶0.64,29.02%和49.02%的患者合并营养不良(差)与合并慢性疾病,其中接受ESD和传统术式治疗者分别为406和459例,占46.94%和53.06%,5年总生存率为66.36%。ESD和传统术式治疗的老年患者治愈性切除率、完整性切除率和术后复发率比较,差异均无统计学意义(P>0.05);但与传统术式相比,ESD治疗者手术时间和术后住院时间短(P<0.05)、术中出血量少(P<0.05)、术中输血率低(P<0.05);ESD治疗者术后出血率、切口感染率、肺部感染率及总并发症发生率均明显低于传统术式(P<0.05)。单因素分析显示,性别、年龄、吸烟史、合并慢性疾病、原发病灶部位、肿瘤大小、病理类型及治疗方式,差异均无统计学意义(P>0.05);而营养状态、分化程度、淋巴结转移与否、术中是否输血和术后是否复发比较,差异均有统计学意义(P<0.05);多因素COX回归分析显示,营养差(RR=1.640,95%CI:1.207~2.235)、中低分化(RR=1.510,95%CI:1.113~2.049)、淋巴结转移(RR=1.412,95%CI:1.013~1.927)、术中输血(RR=1.394,95%CI:1.157~1.679)、术后复发(RR=3.529,95%CI:3.003~4.147)均为影响老年T1期原发性GC患者预后的独立危险因素(P<0.05)。结论ESD与传统术式治疗老年GC患者的临床效果相当,但前者具有手术时间短、出血量少、并发症发生率低和术后恢复快的优点,预后的影响因素有营养状态、分化程度、淋巴结转移、术中输血和术后复发。Objective To analyze the curative effect of endoscopic submucosal dissection(ESD)and traditional surgery on elderly patients with gastric cancer(GC)and influencing factors of prognosis based on SEER database.Methods 865 elderly patients with primary GC at stage T1 who underwent ESD or traditional surgery were enrolled in SEER database during the period from January to December of 2014 were screened out.The curative effect of ESD and traditional surgery was analyzed.The influencing factors of prognosis were analyzed.Results The ratio of male to female in the 865 patients was 1.00~0.64.There were 29.02% and 49.02% of patients with malnutrition(poor)and chronic disease.There were 406 cases and 459 cases underwent ESD and traditional surgery,accounting for 46.94% and 53.06%,respectively.The 5-year overall survival rate was 66.36%.There was no significant difference in healing resection rate,complete resection rate or postoperative recurrence rate between patients underwent ESD and traditional surgery(P>0.05).However,compared traditional surgery,operation time and postoperative hospitalization time were shorter in patients underwent ESD,intraoperative blood loss was less,and intraoperative blood transfusion rate was lower(P<0.05).The incidence rates of postoperative hemorrhage,incision infection and lung infection,and incidence of total complications in patients underwent ESD were lower than those underwent traditional surgery(P<0.05).Univariate analysis showed that differences were not statistically significant in gender,age,smoking history,chronic diseases,primary lesion location,tumor size,pathological type and treatment method(P>0.05),while there differences were statistically significant in nutritional status,differentiation degree,lymph node metastasis,intraoperative blood transfusion and postoperative recurrence(P<0.05).The results of multivariate COX regression analysis showed that poor nutrition(RR=1.640,95%CI:1.207~2.235),moderate to low differentiation(RR=1.510,95%CI:1.113~2.049),lymph node metastasis(RR=1.

关 键 词：SEER数据库 老年 胃癌 内镜黏膜下剥离术 预后 

分 类 号：R735.2[医药卫生—肿瘤]