预后指数模型评价分化型胃癌根治术后辅助性化疗的应用价值研究  

Application value of prognosis index model in evaluating adjuvant chemotherapy after radical gastrectomy of differentiated carcinoma

作　　者：敖栋基 明艳 刘奇 杨正益 AO Dongji;MING Yan;LIU Qi;YANG Zhengyi(Department of Gastroenterology,Bijie First People′s Hospital,Bijie,Guizhou 551700,China)

机构地区：[1]贵州省毕节市第一人民医院消化内科,551700

出　　处：《重庆医学》2021年第2期254-258,共5页Chongqing medicine

基　　金：贵州省科技计划项目(黔科合平台人才[2018]5621)。

摘　　要：目的建立预测分化型(DCA)胃癌根治术后5年生存情况的预后指数(PI)模型,根据PI模型评价DCA胃癌根治术后辅助性化疗的应用价值。方法收集2010年1月至2013年12月于该院接受根治性手术治疗的178例DCA胃癌患者的临床病理资料,采用Cox多因素分析获得影响DCA胃癌根治术后5年生存情况的独立预测因子,在此基础上建立预测DCA胃癌根治术后5年生存情况的PI模型,运用受试者工作特征(ROC)曲线获得PI模型最佳诊断截点,将所有患者分为高危组与低危组,采用Kaplan-Meier生存分析比较高危组和低危组中不同辅助性化疗情况患者各阶段累积生存率。结果建立PI模型:PI=0.54×X1(T1~2=1,T3=2,T4=3)+0.64×X2(否=0,是=1)+0.42×X3(cm)+0.81×X4(否=0,是=1),ROC曲线下面积(AUC)为0.835(0.713~0.943),PI模型最佳诊断截点为1.78;Cox回归模型显示PI值为独立预测因子,Kaplan-Meier生存曲线和Log-rank检验结果显示,低危组(PI值小于或等于1.78)化疗和非化疗患者各阶段累积生存率无明显差异(P>0.05),高危组(PI值大于1.78)化疗患者各阶段累积生存率明显高于非化疗患者(P<0.05)。结论PI模型提示低危患者不推荐辅助性化疗,高危患者予以辅助性化疗可延长术后生存时间,PI模型的建立有助于DCA胃癌根治术后辅助性化疗在临床的合理应用。Objective To establish a prediction index(PI)model on 5-year survival of patients underwent radical gastrectomy of differentiated carcinoma(DCA),and evaluate the application value of adjuvant chemotherapy after radical gastrectomy of DCA according to PI model.Methods The clinicopathological data of 178 patients with DCA gastric cancer underwent radical gastrectomy in our hospital from January 2010 to December 2013 was collected.Cox multivariate analysis were used to analyze the independent predictors of 5-year survival of DCA gastric cancer after radical gastrectomy.On this basis,PI model was established to predict 5-year survival of postoperative DCA gastric cancer,the cut off value of PI model was obtained by receiver operating characteristic(ROC)curve.Patients were divided into the high-risk group and the low-risk group.Kaplan-Meier survival analysis was used to compare the cumulative survival rate at each stage after adjuvant chemotherapy between the high-risk group and the low-risk group respectively.Results PI model was established:PI=0.54×X1(T1-2=1,T3=2,T4=3)+0.64×X2(No=0,Yes=1)+0.42×X3(cm)+0.81×X4(No=0,Yes=1),the area under ROC(AUC)was 0.835(0.713-0.943),the cut off value of PI was 1.78,the Cox regression model showed PI value was an independent predictor.Kaplan-Meier survival curve and Log-rank test showed that the cumulative survival rate at each stage had no significant difference between the chemotherapy patients and the non-chemotherapy patients in the low-risk group(PI≤1.78),the cumulative survival at each stage of the chemotherapy patients was significantly higher than that of the non-chemotherapy patients in the high-risk group(PI>1.78)(P<0.05).Conclusion PI model suggested that adjuvant chemotherapy was not recommended for patients in low-risk,but for patients in high-risk,adjuvant chemotherapy can significantly improve the postoperative survival period.The establishment of PI model is conducive to the rational application of adjuvant chemotherapy in patients with DCA gastric cancer underwe

关 键 词：胃肿瘤 分化型肿瘤 化疗 辅助 预后指数模型 生存分析 

分 类 号：R735.2[医药卫生—肿瘤]