318例原发性胃癌转移及预后影响因素的相关分析  

Correlation of Metastatic and Prognostic Factors in 318 Cases of Primary Gastric Cancer

作　　者：唐嘉黛 杨静[2] 宋红莉 陈娇娇 缪忠惠 谢琳[1] TANG Jiadai;YANG Jing;SONG Hongli;CHEN Jiaojiao;MIAO Zhonghui;XIE Lin(Dept.of Gastrointestinal Oncology,The Third Affiliated Hospital of Kunming Medical University,Tumor Hospital of Yunnan Province,Kunming Yunnan 650118;Dept.of Oncology,The First Hospital of Kunming,Ganmei Hospital,Kunming Yunnan 650118,China)

机构地区：[1]昆明医科大学第三附属医院,云南省肿瘤医院消化肿瘤内科,云南昆明650101 [2]昆明市第一人民医院甘美医院肿瘤科,云南昆明650118

出　　处：《昆明医科大学学报》2023年第2期75-87,共13页Journal of Kunming Medical University

基　　金：云南省科技厅基础研究专项基金资助项目(202101AS070004)。

摘　　要：目的 探索并分析原发性胃癌(gastric cancer,GC)患者转移及预后的影响因素,寻找可早期预测转移的临床指标。方法 回顾性研究云南省肿瘤医院2018年1月至2021年12月期间收治的经病理确诊为原发性GC的318例患者的临床病理资料,根据是否发生转移分为转移组(213例)和未转移组(105例)。分析各临床病理因素与GC转移及预后的关系,并探索各影响因素对转移的诊断效能。结果 (1)生存分析提示转移组中位总生存期(overall survival,OS)及平均无进展生存期(progression-free survival,PFS)分别为27个月和22.16个月,未转移组中位OS及平均PFS分别为45个月和41.98个月,2组间OS及PFS,差异均有统计学意义(P <0.000 1);(2)多因素分析提示浸润深度>黏膜层、未接受化疗及糖类抗原-125(carbohydrate antigen-125,CA-125)≥14.4KU/L是GC患者发生转移的独立危险因素(P<0.05);(3)绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)提示与单指标或双指标联合相比,浸润深度、前白蛋白和CA-125三指标联合后对预测GC患者是否发生转移具有更精确的敏感性及特异性;(4)Log-rank检验及COX多因素分析提示化疗总周期<8周期及CA-125≥14.4 KU/L是转移患者OS的独立危险因素,原发灶未接受手术治疗、初诊合并转移、病程中合并远处转移及CA-125≥14.4 KU/L是转移患者PFS的独立危险因素,差异均有统计学意义(P <0.05)。结论 GC患者一旦发生转移则预后极差,临床中应重视转移的早期发现及诊治,多指标联合对于诊断GC转移具有较精确的敏感性及特异性,提示对GC患者应进行积极评估,制定个体化治疗方案,以期尽早诊治转移灶,为改善患者预后,延长生存期,提高生活质量提供一定的理论基础。Objective To explore the influencing factors of metastasis and prognosis in patients with primary gastric cancer( GC), and trying to find out the clinical indicators for early prediction of metastasis.Methods A retrospective study was conducted on the clinicopathological data of 318 patients with primary GC who were admitted to Yunnan Cancer Hospital from January 2018 to December 2021 and were divided into 2 groups:metastasis group(213 cases) and non-metastasis group(105 cases) according to whether metastasis occurred. The relationship between clinicopathological factors and GC metastasis and prognosis was analyzed,and the diagnostic efficacy of these factors for GC metastasis was explored. Results (1) The median overall survival(OS) and average progression-free survival(PFS) were 27 months and 22.16 months respectively in the metastasis group.While the median OS and average PFS in the non-metastasis group were 45 months and 41.98 months respectively.The differences in OS and PFS between these two groups were statistically significant(P < 0.000 1).(2) Multivariate analysis suggested that infiltration depth > mucosal layer,no chemotherapy and carbohydrate antigen-125(CA-125)≥14.4KU/L were independent risk factors for GC patients with metastasis(P < 0.05).(3) The drawing of receiver operating characteristic curve( ROC curve) suggested that the combination of infiltration depth,prealbumin and CA-125 had more accurate sensitivity and specificity for predicting GC patients’ metastasis than the combination of double single or indexs.( 4) Log-rank test and COX multivariate analysis suggested that total chemotherapy cycle < 8 cycles and CA-125≥14.4KU/L were independent risk factors for OS in patients with metastasis. The independent risk factors for PFS in patients with metastasis were no surgical treatment in the primary lesion,combined with metastasis at initial diagnosis,combined with distant metastasis during the course of disease and CA-125≥14.4KU/L,with statistically significant differences(P < 0.05). Concl

关 键 词：胃癌 临床特征 转移 预后 

分 类 号：R735.2[医药卫生—肿瘤]