神经浸润与胃癌其他临床病理因素的关系及预后分析  

Prognosis analysis and relationship between perineural invasion and gastric cancer and other clinicopathological risk factors

作　　者：刘传绪 王熙勋[1] 胡金晨[1] 姚增武 崔伟豪 蔡莉 姜立新[1] Liu Chuanxu;Wang Xixun;Hu Jinchen;Yao Zengwu;Cui Weihao;Cai Li;Jiang Lixin(The First Department of Gastrointestinal Surgery,Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China;Departmentof Pathology,Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院胃肠外一科,烟台264000 [2]青岛大学附属烟台毓璜顶医院病理科,烟台264000

出　　处：《中华内分泌外科杂志》2022年第2期216-220,共5页Chinese Journal of Endocrine Surgery

基　　金：山东大学项目(3460019005);烟台市科技发展计划(2019MSGY136)。

摘　　要：目的分析神经浸润与胃癌其他临床病理因素的关系及预后的影响。方法回顾性分析2010年1月至2014年12月在青岛大学附属烟台毓璜顶医院行胃癌根治术的665例胃癌患者的临床病理资料,根据患者是否存在神经浸润将其分为神经浸润阳性组和神经浸润阴性组。分析神经浸润与胃癌其他临床病理因素的关系及其对胃癌预后的影响,并使用倾向性评分匹配(PSM)消除两组的潜在混淆偏差后,比较两组胃癌患者5年累积生存率的差异。结果胃癌神经浸润发生率为17.0%(113例),二分类Logistic回归分析显示,肿瘤的浸润深度、脉管癌栓是发生胃癌神经浸润的独立影响因素(P均<0.001)。单因素分析发现年龄(>60岁)、肿瘤直径(>4 cm)、Borrmann分型、浸润深度、淋巴结转移、TNM分期、分化程度、脉管癌栓、神经浸润、癌结节、肿瘤部位、切除部位、手术术式均是胃癌患者预后的影响因素(P均<0.05),但多因素分析显示,年龄(>60岁)、肿瘤直径(>4 cm)、浸润深度、淋巴结转移、脉管癌栓阳性是影响胃癌患者预后的独立危险因素(P<0.05),但神经浸润在多因素分析中不能成为胃癌不良预后的独立影响因素。在进行倾向性匹配评分之后进行生存分析,发现神经浸润阳性组和神经浸润阴性组术后五年生存率差异无统计学意义(34.6%vs 43.0%)(χ^(2)=1.713,P=0.191),两者的生存曲线分析无明显差异。结论神经浸润的胃癌患者预后大多不良,但神经浸润不能作为胃癌预后的独立预后因素。Objective To analyze the relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer.Methods The clinicopathological data of 665 patients with gastric cancer were retrospectively analyzed.According to the presence of perineural invasion,the patients were divided into perineural invasion positive group and perineural invasion negative group.The relationship between perineural invasion and other clinicopathological factors and its effect on the prognosis of gastric cancer were analyzed.After eliminating the potential confusion bias between the two groups by propensity score matching(PSM),the differences of 5-year cumulative survival rate between the two groups of gastric cancer patients were compared.Results The incidence of perineural invasion was 17.0%(113 cases).The binary logistic regression analysis showed that the depth of tumor invasion and vascular tumor thrombus were independent factors influencing the occurrence of gastric cancer perineural invasion(all P<0.001).Univariate analysis showed that age(>60 years),tumor diameter(>4 cm),borrmann classification,depth of invasion,lymph node metastasis,TNM stage,degree of differentiation,vascular tumor thrombus,perineural invasion,tumor nodule,tumor site,resection site,and surgical operation were the influencing factors for the prognosis of patients with gastric cancer(P<0.05),but multivariate analysis showed that age(>60 years),tumor diameter(>4cm),depth of invasion,lymph node metastasis,and positive vascular tumor thrombi were independent risk factors affecting the prognosis of gastric cancer patients(P<0.05).However,perineural invasion cannot be an independent factor influencing the poor prognosis of gastric cancer in a multivariate analysis.Survival analysis was performed after propensity matching scores,and it was found that there was no statistically significant difference in the five-year survival rate between the perineural invasion positive group and the perineural invasion negative group

关 键 词：胃癌 神经浸润 预后 TNM分期 

分 类 号：R73[医药卫生—肿瘤] R656.6[医药卫生—临床医学]