胃癌根治术后临床病理特征及生存预测  

Clinicopathological features and survival prediction after radical resection of gastric cancer

作　　者：马军[1] 周潮平[1] 张亚铭[1] 汪大田[1] 高斌[1] 汤代彬[1] 袁建伟[1] 蒋鹏[1] Ma Jun;Zhou Chaoping;Zhang Yaming;Wang Datian;Gao Bin;Tang Daibin;Yuan Jianwei;Jiang Peng(Department of Surgical Oncology,Anqing Affiliated Hospital of Anhui Medical University,Anqing 246000,China)

机构地区：[1]安庆市立医院肿瘤外科,246000

出　　处：《国际外科学杂志》2021年第11期749-754,F0004,共7页International Journal of Surgery

基　　金：安徽省卫生健康委科研项目(AHWJ2021b117);安庆市立医院院级科研项目(2021aqykj01)。

摘　　要：目的通过分析根治性胃切除患者的临床资料, 从而探讨可能影响胃癌术后生存的预后因素。方法回顾性分析2010年10月—2015年7月安庆市立医院肿瘤外科行胃癌根治术的525例患者的临床资料, 其中男性387例, 女性138例;年龄范围16~89岁, 平均(62.5±10.7)岁。采用COX比例风险回归模型分析资料中的33个变量与预后之间的关系, 并建立ROC曲线, 以探讨影响胃癌根治术后生存的危险因素。结果 1年生存率89.3%, 3年生存率68.4%, 5年生存率为59.6%;Ⅰ期患者5年生存率81.9%, Ⅱ期患者5年生存率71.4%, Ⅲ期患者5年生存率44.1%;多因素生存分析发现:术前合并症(HR=1.595、P=0.001)、血红蛋白(HR=1.377、P=0.017)、CA199(HR=1.618、P=0.004)、肿瘤范围(HR=1.943、P=0.032)、pT期(HR=1.731、P=0.012)、pN期(HR=2.118、P=0.000)、印戒细胞癌(HR=1.642、P=0.038)和脉管内癌栓(HR=1.391、P=0.039)是影响胃癌根治术后生存的独立危险因素。CA199(AUC=0.568)、血红蛋白(AUC=0.586)、术前合并症(AUC=0.554)、pT期(AUC=0.636)、pN期(AUC=0.670)和脉管内癌栓(AUC=0.626)预测术后生存具有一定的准确性(P<0.05)。结论根据ROC曲线分析, 术前合并症、贫血、CA199、pN分期、pT分期和脉管内癌栓具有预测胃癌根治术后远期生存的临床价值。Objective:To explore the prognostic factors that may affect the postoperative survival of gastric cancer by analyzing patients with radical gastrectomy.Methods:The data of 525 patients with radical gastrectomy,including 387 male and 138 female with average age(62.5±10.7)years old(ranged from 16 to 89 years),were analyzed retrospectively in Anqing Municipal Hospital between October 2010 to July 2015.The relationship between 33 variables and prognosis was analyzed by a Cox proportionalhazards regression model,meanwhile ROC curve was established in order to explore the risk factor of postopertive survival.Results:The over survival(OS)rate of all patients was 89.3%at 1 year,68.4%at 3 years and 59.6%at 5 years.The 5-year OS rate was 81.9%at stageⅠ,71.4%at stageⅡand 44.1%at stageⅢ.In the multivariate analysis that included these factors,preoperative comorbidity(HR=1.595,P=0.001),hemoglobin(HR=1.377,P=0.017),CA199(HR=1.618,P=0.004),tumor distribution(HR=1.943,P=0.032),pT stage(HR=1.731,P=0.012),pN stage(HR=2.118,P=0.000),signet ring cell(HR=1.642,P=0.038)and intravascular tumor thrombus(HR=1.391,P=0.039)were independent risk factors associating with postopertive survival.According to ROC curve,the following area(AUC value)could predict survival after radical gastrectomy,including CA199(AUC=0.568),hemoglobin(AUC=0.586),preoperative comorbidity(AUC=0.554),pT stage(AUC=0.636),pN stage(AUC=0.670)and intravascular tumor thrombus(AUC=0.626)(P<0.05).Conclusion:According to ROC curve analysis,preoperative comorbidity,anemia,CA199,pN stage,pT stage and intravascular tumor thrombus played an role in predicting long-term survival after radical resection of gastric cancer.

关 键 词：胃肿瘤 危险因素 预后 胃癌根治术 

分 类 号：R735.2[医药卫生—肿瘤]