初始可切除型胃癌肝转移不同治疗方式预后情况及其影响因素分析的全国多中心临床研究  

Prognosis and influencing factors analysis of patients with initially resectable gastric cancer liver metastasis who were treated by different modalities:a nationwide,multicenter clinical study

作　　者：李力 高云鹤[2] 商亮 唐兆庆[4] 薛侃 余江 梁延锐 何子锐[7] 柯彬 郑华龙 黄华[10] 熊建平 何中原[12] 李佶阳[2] 卢婷婷 宋奇赢 刘诗贺 郗洪庆[2] 唐云[2] 乔治[2] 梁寒 季加孚 陈凛[2] Li Li;Gao Yunhe;Shang Liang;Tang Zhaoqing;Xue Kan;Yu Jiang;Liang Yanrui;He Zirui;Ke Bin;Zheng Hualong;Huang Hua;Xiong Jianping;He Zhongyuan;Li Jiyang;Lu Tingting;Song Qiying;Liu Shihe;Xi Hongqing;Tang Yun;Qiao Zhi;Liang Han;Ji Jiafu;Chen Lin(Graduate School of Chinese PLA General Hospital,Beijing 100853,China;Department of General Surgery,The First Medical Center of Chinese PLA Medical School,Beijing 100853,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Ji'nan 250021,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of General Surgery,Southern Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastrointestinal Surgery,Peking University Cancer Hospital,Beijing 100142,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Gastric Cancer,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China;Department of Gastric Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Gastric Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Pancreatic and Gastric Surgery,Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China;Department of General Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]解放军医学院研究生院,北京100853 [2]解放军总医院第一医学中心普通外科医学部,北京100853 [3]山东第一医科大学附属省立医院胃肠外科,济南250021 [4]复旦大学附属中山医院普通外科,上海200032 [5]南方医科大学南方医院普通外科,广州510515 [6]北京大学肿瘤医院胃肠外科,北京100142 [7]上海交通大学医学院附属瑞金医院普通外科,上海200025 [8]天津医科大学肿瘤医院胃部肿瘤科,天津300060 [9]福建医科大学附属协和医院胃外科,福州350001 [10]复旦大学附属肿瘤医院胃外科,上海200032 [11]中国医学科学院肿瘤医院胰胃外科,北京100021 [12]南京医科大学第一附属医院普通外科,南京210029

出　　处：《中华消化外科杂志》2024年第1期114-124,共11页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81972790);军队后勤科研项目(145BHQ090003000X08);军队装备综合研究项目(LB2022B020200?QZ)。

摘　　要：目的探讨初始可切除型胃癌肝转移(GCLM)不同治疗方式的预后情况,分析预后的影响因素。方法采用回顾性队列研究方法。收集2010年1月至2019年12月基于真实世界数据的GCLM诊疗全国多中心回顾性队列研究数据库中327例初始可切除型GCLM患者的临床病理资料;男267例,女60例;年龄为61(54,68)岁。根据患者具体情况分别行根治性手术联合系统治疗、姑息性手术联合系统治疗、单纯系统治疗。观察指标:(1)不同治疗方式患者临床特征情况。(2)不同治疗方式患者预后情况。(3)初始可切除型GCLM患者预后的影响因素分析。(4)根治性手术联合系统治疗和姑息性手术联合系统治疗潜在获益人群筛选。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ2检验。采用Kaplan-Meier法计算生存率并绘制生存曲线,Log-Rank检验进行生存分析。采用COX风险比例回归模型进行单因素和多因素分析。倾向评分匹配按1∶1最近邻匹配法匹配,卡钳值为0.1。采用森林图筛选不同手术联合系统治疗的潜在获益人群。结果 (1)不同治疗方式患者临床特征情况。327例患者中,行根治性手术联合系统治疗118例,行姑息性手术联合系统治疗164例,行单纯系统治疗45例;3者吸烟、饮酒、胃原发肿瘤部位和肿瘤最大径、肝转移肿瘤部位、转移时限比较,差异均有统计学意义(P<0.05)。(2)不同治疗方式患者预后情况。327例患者的中位总生存时间为19.9个月(95%可信区间为14.9~24.9个月),1、3年总生存率分别为61.3%、32.7%。行根治性手术联合系统治疗、姑息性手术联合系统治疗、单纯系统治疗患者的1年总生存率分别为68.3%、63.1%、30.6%,3年总生存率分别为41.1%、29.9%、11.9%,3者总生存率比较,差异有统计学意义(χ2Objective To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis(GCLM)who were treated by different modalities,and analyze the influencing factors for prognosis of patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected.There were 267 males and 60 females,aged 61(54,68)years.According to the specific situations of patients,treatment modalities included radical surgery combined with systemic treatment,palliative surgery combined with systemic treatment,and systemic treatment alone.Observation indicators:(1)clinical characteristics of patients who were treated by different modalities;(2)prognostic outcomes of patients who were treated by different modalities;(3)analysis of influencing factors for prognosis of patients with initially resectable GCLM;(4)screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was conducted using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.The Kaplan-Meier method was used to calculate survival rate and draw survival curve,and Log-Rank test was used for survival analysis.Univariate and multivariate analyses were conducted using the COX proportional hazard regression model.The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1.The forest plots were utilized to

关 键 词：胃肿瘤 肝转移 手术治疗 系统治疗 预后 影响因素 

分 类 号：R735.2[医药卫生—肿瘤]