腹腔镜远端胃癌D_(2)根治术治疗局部进展期胃癌10年预后及影响因素分析:基于CLASS队列的全国多中心研究  

The 10-year outcome and prognostic factors of laparoscopic D2 radical distal gastrectomy for locally advanced gastric cancer:a CLASS multicenter study

作　　者：陈豪[1] 余佩武 黄昌明[3] 胡建昆[4] 季刚 江志伟 杜晓辉[7] 魏东 卫洪波[9] 李太原[10] 计勇[11] 俞金龙[12] 臧卫东[13] 孙益红[14] 陶凯雄[15] 季加孚[16] 余江[1] 胡彦锋[1] 刘浩[1] 李国新[1] 中国腹腔镜胃肠外科研究组(CLASS研究组) Chen Hao;Yu Peiwu;Huang Changming;Hu Jiankun;Ji Gang;Jiang Zhiwei;Du Xiaohui;Wei Dong;Wei Hongbo;Li Taiyuan;Ji Yong;Yu Jinlong;Zang Weidong;Sun Yihong;Tao Kaixiong;Ji Jiafu;Yu Jiang;Hu Yanfeng;Liu Hao;Li Guoxin;Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)Group(Department of General Surgery&Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of General Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Gastric Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Digestive Surgery,Xijing Hospital of Air Force Medical University,Xi'an 710032,China;Department of General Surgery,Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China;Department of General Surgery,the First Medical Center of the Chinese PLA General Hospital,Beijing 100853,China;Institute of Anal-colorectal Surgery,No.989 Hospital of PLA,Luoyang 471031,He'nan Province,China;Department of Gastrointestinal Surgery,the Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,China;Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Gastrointestinal Surgery,the First People's Hospital of Foshan,Foshan 528000,Guangdong Province,China;Department of General Surgery,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China;Department of Gastrointestinal Surgery,Fujian Medical University Cancer Hospital,Fujian Cancer Hospital,Fuzhou 350014,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Key Laboratory of Carcinogenesi

机构地区：[1]南方医科大学南方医院普通外科广东省胃肠肿瘤精准微创诊疗重点实验室,广州510515 [2]陆军军医大学第一附属医院普通外科,重庆400038 [3]福建医科大学附属协和医院胃外科,福州350001 [4]四川大学华西医院胃肠外科,成都610041 [5]空军军医大学附属西京医院消化外科,西安710032 [6]江苏省中医院南京中医药大学附属医院普通外科,南京210029 [7]解放军总医院第一医学中心普通外科医学部,北京100853 [8]解放军联勤保障部队第九八九医院全军肛肠外科研究所,洛阳471031 [9]中山大学附属第三医院胃肠外科,广州510630 [10]南昌大学第一附属医院普通外科,南昌330006 [11]佛山市第一人民医院胃肠外科,佛山528000 [12]南方医科大学珠江医院普通外科,广州510280 [13]福建医科大学附属肿瘤医院福建省肿瘤医院胃肠肿瘤外科,福州350014 [14]复旦大学附属中山医院普通外科,上海200032 [15]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [16]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [17]不详

出　　处：《中华消化外科杂志》2022年第3期362-374,共13页Chinese Journal of Digestive Surgery

基　　金：广东省胃肠肿瘤精准微创诊疗重点实验室(2020B121201004);广东省重大人才工程(2019JC05Y361)。

摘　　要：目的探讨腹腔镜远端胃癌D2根治术治疗局部进展期胃癌10年预后及影响因素。方法采用回顾性队列研究方法。收集2004年2月至2010年12月中国腹腔镜胃肠外科研究组(CLASS研究组)腹腔镜胃癌外科多中心临床数据库中16家医院收治的652例(陆军军医大学第一附属医院214例、福建医科大学附属协和医院191例、南方医科大学南方医院52例、四川大学华西医院49例、空军军医大学附属西京医院43例、江苏省中医院25例、解放军总医院第一医学中心14例、解放军联勤保障部队第九八九医院12例、中山大学附属第三医院12例、南昌大学第一附属医院10例、佛山市第一人民医院9例、南方医科大学珠江医院7例、福建医科大学附属肿瘤医院7例、复旦大学附属中山医院3例、华中科技大学同济医学院附属协和医院2例、北京大学肿瘤医院2例)局部进展期胃癌患者的临床病理资料;男442例,女210例;年龄为(57±12)岁。患者均行腹腔镜远端胃癌D_(2)根治术。观察指标:(1)手术情况。(2)术后病理学检查情况。(3)术后恢复及并发症情况。(4)随访情况。(5)预后影响因素分析。采用门诊和电话方式进行随访,了解患者术后肿瘤复发转移及生存情况。随访时间截至2020年3月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(Q_(1),Q_(3))或M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验,等级资料比较采用Mann-Whitney U非参数检验。采用寿命表法计算生存率,Kaplan-Meier法绘制生存曲线,Log-Rank检验进行生存分析。采用COX风险回归模型进行单因素和多因素分析。结果(1)手术情况:652例患者中,617例行D2淋巴结清扫术,35例行D2+淋巴结清扫术;348例消化道重建方式为Billroth Ⅱ吻合,218例为Billroth Ⅰ吻合,25例为Roux-en-Y吻合,61例为其他;12例行联合脏器切除;569例术中输血,83例术中未输血。652�Objective To investigate the 10-year outcome and prognostic factors of laparoscopic D_(2) radical distal gastrectomy for locally advanced gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 652 patients with locally advanced gastric cancer who were admitted to 16 hospitals from the multicenter database of laparoscopic gastric cancer surgery in the Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)Group,including 214 cases in the First Affiliated Hospital of Army Medical University,191 cases in Fujian Medical University Union Hospital,52 cases in Nanfang Hospital of Southern Medical University,49 cases in West China Hospital of Sichuan University,43 cases in Xijing Hospital of Air Force Medical University,25 cases in Jiangsu Province Hospital of Chinese Medicine,14 cases in the First Medical Center of the Chinese PLA General Hospital,12 cases in No.989 Hospital of PLA,12 cases in the Third Affiliated Hospital of Sun Yat-Sen University,10 cases in the First Affiliated Hospital of Nanchang University,9 cases in the First People's Hospital of Foshan,7 cases in Zhujiang Hospital of Southern Medical University,7 cases in Fujian Medical University Cancer Hospital,3 cases in Zhongshan Hospital of Fudan University,2 cases in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,2 cases in Peking University Cancer Hospital&Institute,from February 2004 to December 2010 were collected.There were 442 males and 210 females,aged(57±12)years.All patients underwent laparoscopic D_(2) radical distal gastrectomy.Observation indicators:(1)surgical situations;(2)postoperative pathological examination;(3)postoperative recovery and complications;(4)follow-up;(5)prognostic factors analysis.Follow-up was conducted by outpatient examination and telephone interview to detect the tumor recurrence and metastasis,postoperative survival of patients up to March 2020.Measurement data with normal distribution were represented as Mean±SD,and measurement data wi

关 键 词：胃肿瘤 CLASS研究组 腹腔镜手术 局部进展期胃癌 D_(2)淋巴结清扫 远端胃切除 10年总生存 

分 类 号：R735.2[医药卫生—肿瘤]