行根治术的Ⅲ期胃癌患者预后影响因素分析  

Identification of prognostic factors among patients with stage Ⅲ gastric cancer undergoing radical resection

作　　者：许浩 胡碧川 邹伟 段雅斌 XU Hao;HU Bichuan;ZOU Wei;DUAN Yabin(Department of General Surgery,Xiangyang Hospital of Traditional Chinese Medicine,Xiangyang 441099,Hubei,China)

机构地区：[1]襄阳市中医院普外科,湖北襄阳441099

出　　处：《癌变．畸变．突变》2023年第1期30-36,共7页Carcinogenesis,Teratogenesis & Mutagenesis

摘　　要：目的:探讨行根治术的Ⅲ期胃癌患者预后影响因素。方法:选择于2017年1月—2021年4月进行手术治疗的116例Ⅲ期胃癌患者为研究对象,收集患者一般资料和临床指标。比较患者术前血清C反应蛋白(CRP)、细胞程序性死亡-配体1(PD-L1)、促血管生成素-2(Ang-2)浓度与临床病理指标的相关性,采用受试者工作特征(ROC)曲线确定术前血清指标的最佳截断值,采用Kaplan-Meier法分析患者生存情况,建立Cox比例风险回归模型进行多因素分析,通过列线图模型分析各因素在胃癌预后预测中的价值。结果:胃癌患者术前CRP、PD-L1、Ang-2浓度在不同年龄、肿瘤直径、脉管侵犯、神经侵犯、浸润深度、淋巴结转移、淋巴结转移度、分化程度组患者间的差异均具有统计学意义(P<0.05)。生存分析结果显示,术前血清CRP浓度<19.53 mg/L、PD-L1浓度≥42.80 pg/mL、Ang-2浓度<305.16μg/L时患者平均生存期较长、1年生存率较高(P<0.05)。Cox比例风险回归分析结果显示,术前CRP、PD-L1、Ang-2浓度、肿瘤直径、脉管侵犯、神经侵犯、浸润深度、淋巴结转移、分化程度为胃癌患者预后的独立预测因子(P<0.05),列线图预测模型一致性指数为0.863,校准曲线检验表明与实际发生概率具有较高的一致性。结论:胃癌患者根治术前血清CRP浓度超过19.53 mg/L、术前血清PD-L1浓度低于42.80 pg/mL、术前血清Ang-2浓度超过305.16μg/L、肿瘤直径超过5 cm、脉管侵犯、神经侵犯、浸润深度超过T3、淋巴结发生转移、低分化的患者具有较差的预后,检测术前血清CRP、PD-L1、Ang-2浓度及肿瘤直径、脉管和神经侵犯度、浸润深度、淋巴结转移、分化程度等病理指标有助于判断患者远期预后。OBJECTIVE:To identify prognostic factors among patients with stageⅢgastric cancers who underwent radical resections.METHODS:From January 2017 to April 2021,116 patients with stageⅢgastric cancers who underwent surgery were selected.General data and preoperative clinical indicators were collected from these patients.Correlations between serum C-reactive protein (CRP),programmed cell death ligand 1 (PD-L1),angiopoietin-2 (Ang-2) and clinicopathological parameters were compared.The best cut-off value of serum index before operation was determined by receiver operating characteristic (ROC) curve.Survival conditions of the patients was analyzed by Kaplan-Meier method.Cox proportional hazard regression model was established for multi-factor analysis.The value of factors in predicting prognosis of gastric cancers was evaluated using the line chart model.RESULTS:There were significant differences in preoperative CRP,PD-L1 and Ang-2 levels in age,tumor diameter,vascular invasion,nerve invasion,depth of invasion,lymph node metastasis,lymph node metastasis and differentiation.The results of survival analyses showed that the patients with preoperative serum CRPl<19.53 mg/L,PD-L1≥42.80 pg/mL and Ang-2<305.16μg/L had longer survival times and higher 1-year survival rates.The results of Cox proportional hazard regression analyses showed that preoperative CRP,PD-L1,Ang-2,tumor diameter,vascular invasion,nerve invasion,depth of invasion,lymph node metastasis and degree of differentiation were independent predictors of prognosis in patients with gastric cancers (P<0.05).The C-index consistency index of the line chart prediction model was0.863.The calibration curve test showed that the results were highly consistent with the actual occurrence probability.CONCLUSION:In patients with gastric cancers,preoperative serum CRP levels exceeded 19.53mg/L,preoperative serum PD-L1 levels were lower than 42.80 pg/mL,preoperative serum Ang-2 levels exceeded 305.16μg/L,tumor diameters exceeded 5 cm,vascular invasion,nerve invasion,depths

关 键 词：胃癌 C反应蛋白 细胞程序性死亡-配体1 促血管生成素-2 预后 

分 类 号：R730.5[医药卫生—肿瘤]