不同解剖位置癌结节与胃癌患者预后关系分析  

Relationship between different anatomical positions of tumor deposits and prognosis of gastric cancer patients

作　　者：侯越峰 张勇[2] 刘慧慧 任毅楠 王吉[1] 郭宏荣 HOU Yuefeng;ZHANG Yong;LIU Huihui;REN Yinan;WANG Ji;GUO Hongrong(Department of General Surgery,Air Force Hospital of the Central Theater Command of the People's Liberation Army of China,Datong 037006,China;Department of Endoscopy Center,Shanxi Cancer Hospital,Taiyuan 030013,China)

机构地区：[1]中国人民解放军中部战区空军医院普通外科,山西大同037006 [2]山西省肿瘤医院内镜中心,山西太原030013

出　　处：《中国肿瘤外科杂志》2024年第2期136-142,共7页Chinese Journal of Surgical Oncology

基　　金：山西省基础研究计划(202203021221289)。

摘　　要：目的分析接受胃切除术联合全网膜切除术的胃癌患者胃周网膜不同解剖区域癌结节的发生率和临床意义。方法回顾性分析2018年1月至2020年11月在中国人民解放军中部战区空军医院和山西省肿瘤医院接受手术治疗的1127例胃癌患者临床资料。根据癌结节的解剖位置分为3个亚组:①癌结节位于胃小弯侧网膜;②癌结节位于胃大弯侧近端网膜;③癌结节位于胃大弯侧远端网膜。使用COX风险比例回归模型分析影响患者3年OS的独立危险因素及相应风险比(HR)。使用Kaplan-Meier法比较不同位置癌结节胃癌患者的3年总生存期(OS)差异。结果全部患者中,术后病理共检出125例(11.09%)患者存在癌结节。所有位置癌结节均较对应无癌结节的,淋巴血管浸润比例更高、pT分期更差、pTNM分期更差和3年死亡比例更高(P<0.05)。此外,胃大弯近端网膜、胃小弯网膜癌结节者较对应无癌结节者≥60岁比例更高、肿瘤大小≥5 cm比例更高、神经侵犯比例更高、pT分期更差(P<0.05)。多因素COX回归分析可见患者年龄≥60岁、肿瘤大小≥5 cm、pT分期、pN分期、胃大弯近端网膜癌结节是影响患者3年OS的独立危险因素。存在任何位置癌结节患者的3年OS均低于无癌结节的患者(P<0.001)。其中胃大弯近端网膜癌结节患者中位OS最短。结论胃大弯近端网膜癌结节是胃癌患者3年内死亡的危险因素,患者3年OS较短。Objective To analyze the incidence and clinical significance of tumor deposits in different anatomical regions of the perigastric omentum in gastric cancer patients undergoing gastrectomy combined with total omentum resection.Methods A retrospective analysis was conducted on the clinical data of 1,127 gastric cancer patients who underwent surgical treatment from January 2018 to November 2020 in Air Force Hospital of the Central Theater Command of the People's Liberation Army of China and Shanxi Cancer Hospital.According to the anatomical location of tumor deposits,the patients were divided into three subgroups:①tumor deposits were located in the omentum of the lesser curvature of the stomach;②tumor deposits were located in the proximal omentum of the greater curvature of the stomach;③tumor deposits were located in the distal omentum of the greater curvature of the stomach.The Cox risk proportional regression model was used to analyze independent risk factors and corresponding hazard ratios(HR)that affect 3-year OS in patients.Kaplan-Meier method was used to compare the three-year overall survival(OS)of patients with gastric cancer tumor deposits at different locations.Results Among all patients,a total of 125 cases(11.09%)was found to have tumor deposits by postoperative pathology.All locations of tumor deposits have a higher proportion of lymphatic vessel infiltration,worse pT staging,worse pTNM staging,and a higher proportion of 3-year mortality compared to corresponding non-tumor deposits(P<0.05).In addition,compared to patients without corresponding tumor deposits,patients with tumor deposits in the proximal omentum of the greater curvature and in the omentum of lesser curvature of the stomach had a higher proportion over 60 years of age,the tumor size was larger than 5cm,the proportion of nerve invasion was higher,and the pT staging was worse(all P<0.05).Multivariate COX regression analysis showed that age≥60 years,tumor size≥5 cm,pT stage,pN stage,and tumor deposits in the proximal omentum of the

关 键 词：胃癌 癌结节 根治术 预后 

分 类 号：R735.2[医药卫生—肿瘤]