回顾性分析342例胃癌患者临床病理资料重新定义胃硬癌  

Retrospective analysis the clinical pathology in 342 gastric cancer patients and redefine the scirrhous gastric cancer

作　　者：王春云 唐艳[2] 阳乐彬 谢文彪 Wang Chunyun;Tang Yan;Yang Lebin;Xie Wenbiao(Departmeng of Gastrointestinal Surgery,the Second Hospital University of South China,Hengyang 421001,China;Deparment of Hepatopancreatobliliary Surgery,the First Hospital University of South China,Hengyang 421001,China)

机构地区：[1]南华大学附属第二医院胃肠外科,衡阳421001 [2]南华大学附属第一医院肝胆胰外科,衡阳421001

出　　处：《国际外科学杂志》2021年第8期531-537,F0004,共8页International Journal of Surgery

基　　金：湖南省技术创新引导计划临床医疗技术创新引导项目(2017SK50209)。

摘　　要：目的:进一步认识胃硬癌(SGC)的临床特点,明确SGC的定义,分析SGC与非胃硬癌(NSGC)间的临床病理差异和预后。方法:回顾性分析南华大学附属第二医院2011年5月—2018年5月手术治疗的342例胃癌患者临床病理资料(性别、年龄、病理分期、T期等),通过术前内镜、CT影像、肿瘤间质比(TSR)和术后标本的大体外观来定义SGC。采用Pearsonχ^(2)检验或配对t检验分析SGC与NSGC之间各临床病理参数的差异,采用Kaplan-Meier法分析其对患者预后的影响。采用倾向性评分匹配将SGC和NSGC患者进行1∶1匹配,比较两者的生存期差异。结果:共收集342例手术切除的胃癌患者资料,其中49例(14.3%)定义为SGC。相对于NSGC患者,SGC患者更年轻,术后病理分期更晚,更容易出现淋巴结转移。SGC较NSGC有更高的全胃切除率,更容易发生神经/脉管侵犯和网膜种植转移(P<0.01)。SGC患者中位生存期及术后1、3、5年的总生存期均短于NSGC患者,为影响患者预后的独立危险因素。结论:通过内镜、CT、肿瘤间质比、肿瘤大体外观等指标综合定义SGC是可行的,可以认为SGC是一种特殊存在的实体肿瘤,具有分化程度低、病理分期晚、预后差等特点。如何在疾病早期发现并确诊SGC,并进行早期干预是将来发展的方向。Objective:To further understand the clinical characteristics of scirrhous gastric cancer(SGC)and clear it definitions.Analyzed the clinicopathologic features and prognosis of patients with SGC and Non SGC(NSGC).Methods:The study included 342 gastric cancer patients who had undergone gastrectomy in the Second Hospital University of South China between May 2011 and May 2018.The SGC was diagnosed by endoscopic,CT,tumor stroma ratio and appearance of surgical specimen clinicopathological characteristics were summarized and compared between SGC patients and NSGC using pearson′sχ^(2)test or student′s t test.Survival curves were estimated with the Kaplan-Meier method.Patients were matched 1∶1 using propensity score matching,and their overall survival rates were compared.Results:A total of 342 patients with gastrectomy were collected,49(14.3%)were diagnosed as SGC.Patients with SGC were younger,later pathological stage lymph node metastases tend to occur than those(NSGC).SGC had a higher total gastric resection rate,easier prone to nerve/vascular invasion and omental metastasis(P<0.01).The median survival of SGC patients and overall survival at 1,3,and 5 years after surgery were shorter than NSGC patients,which were independent risk factors affecting the prognosis of patients.Conclusions:SGC can be well defined by endoscopy,CT,TSR and tumor appearance.It is a peculiar solid tumor with poor differentiated,advanced stage and poor prognosis.Future research should focus on how to diagnose SGC earlier and intervene in time.

关 键 词：胃肿瘤 胃镜 诊断 生存分析 

分 类 号：R735.2[医药卫生—肿瘤]