不同TNM分期老年胃癌患者临床特征及术后并发肠漏的影响因素分析  

Clinical characteristics of elderly patients with gastric cancer at different TNM stages and analysis of influencing factors of postoperative intestinal leakage

作　　者：李贇 赵黎[1] 梁海滨[1] LI Yun;ZHAO Li;LIANG Hai-bin(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《临床和实验医学杂志》2023年第15期1605-1608,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(编号:82173081)。

摘　　要：目的分析不同TNM分期老年胃癌患者临床特征及术后并发肠漏的影响因素。方法回顾性分析2019年3月至2022年3月上海交通大学医学院附属新华医院收治的200例老年胃癌患者的临床资料,根据TNM分期将其分为Ⅰ/Ⅱ组(n=68)、Ⅲ/Ⅳ组(n=132),比较两组临床特征[性别、年龄、分化程度、浸润深度、有无转移、癌胚抗原(CEA)、糖类抗原199(CA199)、磷酸化蛋白激酶B(PKB/AKT)、脾酪氨酸蛋白激酶(Syk)蛋白表达情况]。另根据术后是否并发肠漏将其分为并发组(n=114)、非并发组(n=86)。对两组一般资料(包括性别、年龄、肿瘤直径、TNM分期、手术方式、是否合并脏器切除、术中出血量、术前血红蛋白、白蛋白)进行比较,将其中有明显差异的变量纳入多因素Logistic回归分析,筛选出影响老年胃癌患者术后并发肠漏的独立危险因素。结果Ⅲ/Ⅳ组低分化程度、黏膜层以下、淋巴结转移、远处转移、PKB/AKT阳性表达占比及CEA、CA199水平分别为55.30%、66.67%、74.24%、43.18%、79.55%、(22.41±1.36)ng/mL、(37.55±1.89)U/mL,均高于Ⅰ/Ⅱ组[14.71%、6.62%、17.65%、2.94%、57.35%、(7.15±0.62)ng/mL、(20.05±1.27)U/mL],Syk阳性表达占比为12.88%,低于Ⅰ/Ⅱ组(39.71%),差异均有统计学意义(P<0.05)。经Pearson检验发现,TNM分期与浸润深度、有淋巴结转移、有远处转移、CEA高表达、CA199高表达、PKB/AKT阳性表达均呈正相关(r=0.817、0.820、0.814、0.855、0.826、0.834,P<0.05),与分化程度、Syk阳性表达均呈负相关(r=-0.802、-0.811,P<0.05)。并发组肿瘤直径为(5.48±1.45)cm,长于非并发组[(3.14±0.83)cm],胸腹联合手术、合并脏器切除占比及术中出血量分别为35.09%、29.82%、(331.70±27.46)mL,均高于非并发组[4.65%、16.28%、(204.65±14.20)mL],术前血红蛋白、术前白蛋白水平分别为(115.12±10.85)、(34.57±4.89)g/L,均低于非并发组[(134.31±11.87)、(42.50±5.85)g/L],差异均有统计学意义(P<0.Objective To analyze the clinical characteristics of elderly gastric cancer patients with different TNM stages and the influencing factors of postoperative intestinal leakage.Methods The clinical data of 200 elderly patients with gastric cancer admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2019 to March 2022 were retrospectively analyzed.They were divided into group Ⅰ/Ⅱ(n=68)and group Ⅲ/Ⅳ(n=132)according to TNM stage,and the clinical characteristics of the two groups[sex,age,degree of differentiation,depth of invasion,metastasis,carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),phosphorylated protein kinase B(PKB/AKT),spleen tyrosine protein kinase(Syk)protein expression of the two groups were compared]were compared.In addition,the patients were divided into concurrent group(n=114)and non-concurrent group(n=86)according to whether postoperative intestinal leakage occurred.The general data of the two groups were compared,and the variables with significant differences were included in the multivariate logistic regression analysis to screen out the independent risk factors affecting postoperative intestinal leakage in elderly patients with gastric cancer.Results The proportion of low differentiation,submucosa,lymph node metastasis,distant metastasis,PKB/AKT positive expression and the level of CEA and CA199 in group Ⅲ/Ⅳ were 55.30%,66.67%,74.24%,43.18%,79.55%,(22.41±1.36)ng/mL,(37.55±1.89)U/mL,respectively,which were higher than those in group Ⅰ/Ⅱ[14.71%,6.62%,17.65%,2.94%,57.35%,(7.15±0.62)ng/mL,(20.05±1.27)U/mL],the percentage of positive expression of Syk was 12.88%,which was lower than that in group Ⅰ/Ⅱ(39.71%),the differences were statistically significant(P<0.05).Pearson test showed that TNM stage was positively correlated with the depth of invasion,lymph node metastasis,distant metastasis,CEA high expression,CA199 high expression,PKB/AKT positive expression(r=0.817,0.820,0.814,0.855,0.826,0.834;P<0.05),and negatively co

关 键 词：TNM分期 胃癌 临床特征 肠漏 影响因素 

分 类 号：R735.2[医药卫生—肿瘤]