残胃癌患者脉管癌栓与临床病理特征和预后的关系  

Association of lymphovascular invasion with clinicopathologic features and prognosis of gastric stump cancer

作　　者：王益[1] 魏晟宏[1] 叶再生[1] 林振孟 曾奕[1] 陈书[1] 林志涛 陈小玲[1] 陈路川[1] Yi Wang;Shenghong Wei;Zaisheng Ye;Zhenmeng Lin;Yi Zeng;Shu Chen;Zhitao Lin;Xiaoling Chen;Chuan ChenLu(Department of Gastrointestinal Surgery,Fujian Medical University Cancer Hospital,Fujian Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建医科大学附属肿瘤医院福建省肿瘤医院胃肠外科,福州市350014

出　　处：《中国肿瘤临床》2021年第24期1266-1271,共6页Chinese Journal of Clinical Oncology

基　　金：福建省卫健委科技计划项目(编号:2020QNA016)资助。

摘　　要：目的:探讨残胃癌患者脉管癌栓与临床病理特征和预后的关系。方法:回顾性分析1999年3月至2020年3月福建医科大学附属肿瘤医院接受手术治疗(包括根治性和姑息性手术)的208例残胃癌患者的临床病例资料。根据肿瘤是否有脉管癌栓,分为脉管癌栓组(118例)及无脉管癌栓组(90例),比较两组的临床病理学特征、手术及淋巴结清扫情况及生存预后的差异。结果:两组在浸润深度、淋巴结转移、TNM分期、组织分型、神经浸润及Borrmann分型的分布差异均具有统计学意义(均P<0.05)。多因素分析显示:神经浸润、脉管癌栓、肿瘤大小、TNM分期、联合脏器切除是影响残胃癌患者预后的独立危险因素(P<0.05)。两组在手术时间及淋巴结转移数目上差异具有统计学意义(P<0.05)。全组术后5年生存率为45.6%,其中脉管癌栓组与无脉管癌栓组5年生存率分别为28.8%和66.0%,差异具有统计学意义(P<0.05)。肿瘤大小≥5 cm、TNMⅡ期和TNMⅢ期的脉管癌栓组和无脉管癌栓组残胃癌患者术后5年生存率分别为20.2%vs.59.6%、44.1%vs.82.2%和19.9%vs.42.7%,差异具有统计学意义(P<0.05)。结论:脉管癌栓是判断残胃癌患者预后的重要指标。有脉管癌栓的残胃癌术后患者,尤其是肿瘤大小≥5 cm、TNMⅡ期或TNMⅢ期的更需要积极的辅助治疗。Objective:To investigate the association of lymphovascular invasion(LVI)with the clinicopathologic features and prognosis of gastric stump cancer.Methods:The clinical data of 208 patients with gastric stump cancer who received treatment(radical and palliative resection)from March 1999 to March 2020 in Fujian Medical University Cancer Hospital were analyzed.The patients were assigned into two groups according to whether the tumor demonstrated LVI;118 patients were assigned to the tumor-with-LVI group and 90 to the tumorwithout-LVI group.The clinicopathologic characteristics,lymph node metastasis,operative data,and prognostic differences were compared between the two groups.Results:LVI was correlated with the depth of invasion,lymph node metastasis,TNM stage,histological type,perineural invasion,and Borrmann classification(P<0.05).Multivariate analysis showed that perineural invasion,LVI,tumor size,TNM stage,and combined organ resection were independent risk factors for the prognosis of patients with gastric stump cancer(P<0.05).There were significant differences in the operative time and lymph node metastasis between the two groups(P<0.05).The 5-year overall survival rate of all included patients was 45.6%,being 28.8%and 66.0%for patients with gastric cancer with and without LVI,respectively.The difference was statistically significant between the two groups(P<0.05).In gastric stump cancer with tumor size≥5 cm,TNM stageⅡ,and TNM stageⅢ,the 5-year overall survival rates of patients with and without LVI were 20.2%and 59.6%,44.1%and 82.2%,and 19.9%and 42.7%,respectively.The difference was statistically significant between the two groups(P<0.05).Conclusions:LVI is an important index in determining the prognosis of patients with gastric stump cancer.Patients with LVI,especially those with tumor size≥5 cm,TNM stageⅡ,or TNM stageⅢ,need more active adjuvant therapy.

关 键 词：残胃癌 脉管癌栓 预后 

分 类 号：R735.2[医药卫生—肿瘤]