胃癌患者出现癌结节的危险因素及预后影响分析  

Risk factors and prognostic impact of tumor deposits in patients with gastric cancer

作　　者：潘浩 王华南 张红雨[1] 赵春临[1] Pan Hao;Wang Huanan;Zhang Hongyu;Zhao Chunlin(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院胃肠外科,郑州450000

出　　处：《河南外科学杂志》2023年第6期1-5,共5页Henan Journal of Surgery

基　　金：国家自然科学基金资助项目(81902475)。

摘　　要：目的探讨胃癌患者出现癌结节的危险因素及其预后影响。方法回顾性分析2015-01—2018-06郑州大学第一附属医院胃肠外科收治的462例确诊为胃癌并行根治性胃切除术+D2淋巴结清扫术患者的临床资料,按照是否出现癌结节分为癌结节阳性组和癌结节阴性组。比较2组患者的临床病理特征、5 a生存率和5 a无瘤生存率。单因素分析采用χ^(2)检验或Fisher确切概率法比较,将单因素分析有统计学意义的因素纳入多因素Logistic回归模型中。采用Kaplan-Meier法绘制生存曲线,生存率的比较采用Log-rank检验。P<0.05表示差异有统计学意义。结果单因素分析显示,肿瘤大小、肿瘤部位、大体类型、印戒细胞成分、T分期、N分期、TNM分期、脉管浸润和神经侵犯,是胃癌患者出现癌结节的影响因素(P<0.05);多因素分析显示,含印戒细胞成分(OR=4.207,95%CI:1.851~9.562,P<0.05)、N分期较晚(OR=1.643,95%CI:1.071~2.522,P<0.05)和脉管浸润阳性(OR=2.614,95%CI:1.095~6.238,P<0.05)是胃癌患者出现癌结节的独立危险因素;生存分析显示,癌结节阳性患者的5 a生存率和无瘤生存率均劣于癌结节阴性患者,差异有统计学意义(P<0.05)。亚组分析显示,Ⅰ期胃癌患者,癌结节阳性组与癌结节阴性组生存率的差异无统计学意义(P>0.05);Ⅱ、Ⅲ期胃癌患者,癌结节阳性组生存率劣于癌结节阴性组,差异有统计学意义(P<0.05)。对于癌结节阳性的胃癌患者,完成辅助化疗可以显著改善总生存时间和无瘤生存时间(P<0.05)。结论含印戒细胞癌成分、N分期较晚、脉管浸润阳性是胃癌患者出现癌结节的高危因素,癌结节阳性患者的预后不良,术后辅助化疗可以改善癌结节阳性患者的预后。Objective To investigate the risk factors and their prognostic impact in patients with gastric cancer presenting with tumor deposits.Methods We retrospectively reviewed the clinical medical records of 462 patients diagnosed with gastric cancer who underwent radical gastrectomy+D2 lymph node dissection in the Department of Gastroenterological Surgery at the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018.Patients were divided into two tumor nodule positive and tumor nodule negative groups according to the presence or absence of tumor nodule,and compared the two groups for each clinicopathological characteristics,5-year survival rate and 5-year tumor free survival rate.Univariate analysis was performed usingχ^(2)Factors that were statistically significant on univariate analysis were included in a multivariate Logistic regression model using theχ^(2)test or Fisher's exact probability method.The Kaplan Meier method was used to draw survival curves,and comparisons of survival rates were performed using the log rank test.Differences were considered statistically significant(P<0.05).Results Univariate analysis showed that tumor size,tumor location,gross type,signet ring cell component,T stage,N stage,TNM stage,vascular invasion,and nerve invasion were significant factors associated with the occurrence of tumor nodule in patients with gastric cancer(P<0.05);Multivariate analysis showed that signet ring cell containing component(OR=4.207,95%CI:1.851~9.562,P<0.05),later N stage(OR=1.643,95%CI:1.071~2.522,P<0.05)and positive vasculature invasion(OR=2.614,95%CI:1.095~6.238,P<0.05)were independent risk factors for the occurrence of tumor nodule in gastric cancer patients;Survival analysis showed that the 5-year survival rate and tumor free survival rate of patients with positive tumor nodule were both inferior to those of patients with negative tumor nodule,and the differences were statistically significant(P<0.05).Subgroup analysis showed that there was no significant difference in survival

关 键 词：胃癌 癌结节 危险因素 预后 辅助化疗 

分 类 号：R735.2[医药卫生—肿瘤]