影响胃癌根治术后早期复发的危险因素分析  

Analysis o frisk factors of early recurrence post radical resection of gastric cancer

作　　者：刘苗 王英南[1] 张韶辰 张瑞星[1] LIU Miao;WANG Yingnan;ZHANG Shaochen;ZHANG Ruixing.(Department of Gastroenterology, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, China)

机构地区：[1]河北医科大学第四医院消化内科,石家庄050000

出　　处：《临床肿瘤学杂志》2020年第10期905-910,共6页Chinese Clinical Oncology

摘　　要：目的探索影响胃癌根治术后早期复发的独立危险因素,为预防胃癌早期复发提供理论依据。方法回顾性分析2014年1月1日至2016年09月30日于河北医科大学第四医院行D2根治术且达R0切除的胃癌患者的病历资料及随访资料共268例。首先通过单因素分析筛选影响胃癌根治术后早期复发的危险因素,然后通过多因素分析筛选影响胃癌根治术后早期复发的独立危险因素,最后根据Lauren分型及TNM分期进行分层分析,分别筛选引起不同Lauren分型及不同TNM分期胃癌根治术后早期复发的独立危险因素。结果术后辅助化疗方案、是否术前新辅助化疗、辅助化疗周期数、浸润深度、TNM分期、肿瘤最大直径、淋巴结阳性率、脉管瘤栓和首诊时PLR是影响胃癌根治术后早期复发的因素。术后辅助化疗方案、辅助化疗周期数、浸润深度、淋巴结阳性率是影响胃癌根治术后早期复发的独立因素。依据Lauren分型进行分层,淋巴结阳性率、是否术前新辅助化疗、首诊时PLR是影响肠型胃癌早期复发的独立因素。淋巴结阳性率是影响弥漫型胃癌早期复发的独立因素。HER-2是影响混合型胃癌早期复发的独立因素。依据TNM分期进行分层分析,首诊时PLR是影响Ⅱ期胃癌早期复发的独立因素,术后辅助化疗方案、辅助化疗周期数、淋巴结阳性率是影响Ⅲ期胃癌早期复发的独立因素。结论浸润深度大于T3及淋巴结阳性率较高的胃癌患者应高度预警早期复发的风险,接受足疗程的辅助化疗,可减少早期复发的发生。在预防胃癌早期复发方面,SOX方案辅助化疗的疗效不劣于XELOX方案。不同Lauren分型胃癌有其独特的早期复发危险因素。Objective To explore the independent risk factors affecting early recurrence of gastric cancer post radical operation,and to provide evidence for preventing early recurrence of gastric cancer.Methods The clinical records and follow-up data of 268 patients with gastric cancer who underwent D2 radical resection and R0 resection in the fourth Hospital of Hebei Medical University from January 1,2014 to September 30,2016 were retrospectively analyzed.Firstly,the risk factors of early recurrence post radical resection of gastric cancer were screened by univariate analysis,and then the independent risk factors of early recurrence post radical operation of gastric cancer were selected by multi-factor analysis.Finally,the stratified analysis was carried out according to the Lauren type and the TNM stage,independent risk factors of early recurrence post radical resection of gastric cancer with different Lauren type and TNM stage were screened.Results Adjuvant chemotherapy regimen,preoperative neoadjuvant chemotherapy,number of adjuvant chemotherapy cycles,depth of invasion,TNM stage,maximum diameter of tumor,positive rate of lymph node,vascular tumor embolus,PLR at the first visit were risk factors for early recurrence of gastric cancer post radical operation.The adjuvant chemotherapy regimen,the number of adjuvant chemotherapy cycles,the depth of invasion and the positive rate of lymph nodes were independent risk factors for early recurrence of gastric cancer post radical operation.Stratified analysis according to Lauren classification,positive rate of lymph node,preoperative neoadjuvant chemotherapy,PLR at the first visit were independent risk factors for early recurrence of intestinal type gastric cancer.The positive rate of lymph nodes was an independent risk factor for early recurrence of diffuse type gastric cancer and HER-2 was an independent risk factor for early recurrence of mixed gastric cancer.Stratified analysis according to TNM stage,PLR at the first visit were independent risk factors for early recurrence of

关 键 词：胃癌 早期复发 辅助化疗方案 Lauren分型 

分 类 号：R735.2[医药卫生—肿瘤]