Ⅲ期胃癌D2根治术后辅助放化疗患者长期预后的影响因素:基于10年随访数据  

Risk Factors Analysis of Long-term Prognosis in Patients with D2 Radical Surgery for Stage Ⅲ Gastric Cancer after Adjuvant Chemoradiotherapy:Based on the Data of 10-year Follow-up

作　　者：马桂芬 章倩[1,2] 刘娟 孙菁 林根来[1,2] MA Guifen;ZHANG Qian;LIU Juan;SUN Jing;LIN Genlai(Department of Radiation Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Cancer Prevention and Control Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiation Oncology,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361000,China)

机构地区：[1]复旦大学附属中山医院放疗科,上海市200032 [2]复旦大学附属中山医院肿瘤防治中心,上海市200032 [3]复旦大学附属中山医院厦门分院放疗科,福建省厦门市361000

出　　处：《中国全科医学》2024年第17期2091-2097,共7页Chinese General Practice

基　　金：福建省自然科学基金项目(2023J05296)。

摘　　要：背景局部进展期胃癌主要包括Ⅲ期胃癌,以综合治疗为主,患者术后复发是影响患者预后的关键因素。目的探究Ⅲ期胃癌D2根治术后辅助放化疗患者长期预后的影响因素。方法选取2009—2014年在复旦大学附属中山医院放疗科行D2根治术后辅助放化疗的胃癌患者为研究对象,病理结果根据国际癌症联合会(UICC)和美国肿瘤联合会(AJCC)第八版胃癌TNM分期系统进行分期,明确诊断Ⅲ期胃癌。术后所有患者在第1年每3个月随访1次,之后2年内每6个月随访1次,而后每年随访1次。随访截止日期为2021-12-15。采用Log-rank检验比较生存率的差异,采用Cox比例风险回归分析探究患者总生存时间(OS)和无病生存时间(DFS)的影响因素,列线图预测临床病理特征对预后的影响,Kaplan-Meier法比较不同pTNM分期、年龄、转移淋巴结率(LNR)、胃切除方式患者生存差异。结果共纳入行术后辅助放疗的Ⅲ期胃癌患者135例,中位随访时间10.48年。5年内复发70例,死亡62例,5年无病生存率、总生存率分别为48.1%(65/135)、54.1%(73/135);10年内复发74例,死亡74例,10年无病生存率、总生存率均为45.2%(61/135)。Log-rank检验结果显示,不同pTNM分期、pT分期、LNR、癌结节、肿瘤位置、胃切除方式患者5年生存率比较,差异有统计学意义(P<0.05)。不同pTNM分期、pT分期、LNR、神经浸润、胃切除方式患者10年生存率比较,差异有统计学意义(P<0.05)。多因素Cox比例风险回归分析结果显示,pTNM分期(ⅢA期,OS:HR=0.40,95%CI=0.19~0.83;DFS:HR=0.40,95%CI=0.19~0.92)、LNR(>50%,OS:HR=1.74,95%CI=1.03~2.94;DFS:HR=1.73,95%CI=1.02~2.94)、胃切除方式(全胃切除术,OS:HR=2.07,95%CI=1.22~3.50;DFS:HR=2.02,95%CI=1.20~3.41)是Ⅲ期胃癌D2根治术后辅助放化疗患者OS和DFS的独立影响因素(P<0.05),年龄(≤40岁,HR=2.19,95%CI=1.06~4.53)是Ⅲ期胃癌D2根治术后辅助放化疗患者OS的独立影响因素(P<0.05)。另外,列线图表明�Background Locally advanced gastric cancer mainly includes stage Ⅲ gastric cancer,which is mainly treated with comprehensive therapy.Postoperative recurrence is a key factor affecting the prognosis of patients.Objective To explore the influencing factors of long-term prognosis in patients with stage Ⅲ gastric cancer undergoing D2 radical surgery and adjuvant chemotherapy.Methods Gastric cancer patients who underwent D2 radical surgery and adjuvant chemoradiotherapy were collected from the Department of Radiotherapy at Zhongshan Hospital affiliated to Fudan University from 2009 to 2014.They were pathologically diagnosed with stage Ⅲ gastric cancer according to the International Union of Cancer(UICC)and American Cancer Federation(AJCC)8th edition TNM staging system for gastric cancer.All postoperative patients were followed up every 3 months in the first year,every 6 months for the following 2 years,and once a year thereafter.The deadline for follow-up is December 15,2021.Survival rates of subgroups were compared using Log-rank tests.The influencing factors of overall survival(OS)and disease-free survival(DFS)were compared using Cox proportional hazards regression analysis,and the prediction of clinicopathological features were analyzed by Nomogram.Comparison of survival differences among patients with different pTNM stagings,age,metastatic lymph node radios(LNR),and gastrectomy methods using Kaplan-Meier method.Results A total of 135 qualified patients were included,with a median follow-up time of 10.48 years.Within 5 years,there were 70 cases of recurrence and 62 deaths.The 5-year DFS rate and OS rate were 48.1%(65/135)and 54.1%(73/135),respectively;Within 10 years,there were 74 cases of recurrence and 74 deaths.The 10-year DFS rate nd OS rate were both 45.2%(61/135).The Log-rank test results showed that there was a statistically significant difference in 5-year survival rates among patients with different pTNM stagings,pT stagings,LNRs,cancer nodules,tumor locations,and gastrectomy methods(P<0.05).The 10-y

关 键 词：胃肿瘤 D2切除术 辅助放化疗 预后 存活率 无病生存时间 影响因素分析 

分 类 号：R735.2[医药卫生—肿瘤]