胃癌根治术后腹膜复发的危险因素分析  

Analysis of risk factors of peritoneal recurrence in patients with gastric cancer after radical surgery

作　　者：付超 胡延伟 张婉琼 赵晓天 FU Chao;HU Yanwei;ZHANG Wanqiong;ZHAO Xiaotian(Anesthesia Department in Operating Room,Xingtai Central Hospital,Xingtai,Hebei 054000,China;Department of Gastrointestinal Surgery,Xingtai Central Hospital,Xingtai,Hebei 054000,China;Outpatient Operating Room,Xingtai Central Hospital,Xingtai,Hebei 054000,China)

机构地区：[1]邢台市中心医院手术室麻醉科,河北邢台054000 [2]邢台市中心医院胃肠外科,河北邢台054000 [3]邢台市中心医院门诊手术室,河北邢台054000

出　　处：《安徽医药》2024年第2期303-308,共6页Anhui Medical and Pharmaceutical Journal

基　　金：邢台市重点研发计划自筹项目(2020ZC366)。

摘　　要：目的探讨胃癌根治术后腹膜复发的危险因素。方法收集2010年1月至2018年12月邢台市中心医院接受胃癌根治术的861例胃腺癌病人的一般资料,按7∶3随机分为训练集(603例)和测试集(258例),并根据术后复发情况将全组病人分为腹膜复发组与非腹膜复发组。在训练集中,采用logistic回归模型分析影响术后腹膜复发的独立相关因素,并建立列线图预测模型。分别应用受试者操作特征(ROC)曲线与校准曲线在训练集与测试集中评估模型的预测准确性与一致性。根据列线图分数将全组病人分为3个风险组,比较不同风险组的术后腹膜复发率与化疗获益。结果861例胃癌病人中,99例发生了术后腹膜复发。单因素分析显示,年龄、性别、组织学分级、Lauren分型、pT分期、pN分期、脉管与神经侵犯、辅助化疗与术后腹膜复发显著相关(P<0.05)。基于向后逐步回归法的多因素分析显示,年龄<60岁、女性、弥漫型肿瘤、病理分期晚期是术后腹膜复发的独立危险因素(P<0.05)。基于以上指标构建列线图预测模型,该模型在训练集与测试集中均具有良好的预测准确性(AUC=0.83)与一致性(Hosmer-Lemeshow P>0.05)。根据列线图分数将全组病人分为低、中、高风险组,3组病人的腹膜复发率分别为1.9%、17.3%、50.0%。不同风险组病人经辅助化疗后其腹膜复发的风险均未发生明显降低。结论年龄<60岁、女性病人与弥漫型、进展期肿瘤是影响胃癌根治术后腹膜复发的独立危险因素。Objective To investigate the risk factors for peritoneal recurrence in patients with gastric cancer(GC).Methods Data on 861 GC patients were collected in Xingtai Central Hospital fromJanuary 2010toDecember 2018.Patients were randomly classified into the training set(n=603)and testing set(n=258)in a ratio of 7∶3,and were classified into the peritoneal-recurrence(PR)and non-PR groups according to the recurrence status.Logistic regression model was used to identify the independent predictive factors for peri-toneal recurrence in the training set.A nomogram was then constructed based on these factors.The predictive accuracy and good fit of the nomogram were evaluated by the receiver operating characteristic curve and calibration curve in both training and testing sets,re-spectively.The entire cohort was divided into three risk groups according to the nomogram.The incidence rate of peritoneal recurrence and chemotherapeutic benefits were compared among groups.Results Of the 861 GC patients,99 cases experienced peritoneal recur-rence.Univariate analysis revealed that age,gender,histological grade,Lauren type,pT stage,pN stage,lymphovascular invasion,neural invasion,and adjuvant chemotherapy were significantly associated with the risk of postoperative peritoneal recurrence(P<0.05).Multi-variate analysis with backward stepwise regression revealed that age<60 years,female gender,diffuse tumors,and advanced tumors were independent risk factors for postoperative peritoneal recurrence(P<0.05).A nomogram constructed based on these factors demon-strated high predictive accuracy(AUC=0.83)and good fit(Hosmer-Lemeshow P>0.05).Based on the nomogram,the entire cohort was divided into the low-,middle-,and high-risk groups.The incidence rates of peritoneal recurrence in these three groups were 1.9%,17.3%,and 50.0%,respectively.The receipt of adjuvant chemotherapy failed to decrease the incidence rates of peritoneal recurrence in these three groups.Conclusion Age<60 years,female gender,diffuse tumors,and advanced tumors were indepen

关 键 词：胃肿瘤 胃切除术 腹膜复发 列线图预测模型 化疗获益 

分 类 号：R735.2[医药卫生—肿瘤]