中国标准下残胃癌的临床病理特征及预后影响因素  

Clinical pathological characteristics and prognostic factors of remnant gastric cancer under Chinese criteria

作　　者：胡贤生 王华摄[2] 林义佳[2] 陈永和[2] 练磊[2] 彭俊生[2] HU Xian-sheng;WANG Hua-she;LIN Yi-jia;CHEN Yong-he;LIAN Lei;PENG Jun-sheng(Department of Coloproctology,Foshan Hospital of TCM,Foshan 528000,Guangdong,China;不详)

机构地区：[1]佛山市中医院肛肠科,广东佛山528000 [2]中山大学附属第六医院胃肠外科(胃外科),广东广州510655

出　　处：《广东医学》2024年第5期590-595,共6页Guangdong Medical Journal

基　　金：中山大学附属第六医院临床医学研究“1010”计划项目[1010CG(2020)-08]。

摘　　要：目的探讨不同定义下残胃癌的临床病理特征和预后,以及中国标准下残胃癌的预后影响因素。方法采用回顾性队列研究方法。收集中山大学附属第六医院病例数据库中2008年9月至2022年11月期间收治的残胃癌变(残胃上的癌)患者和普通胃癌患者的临床资料。采用倾向性评分匹配(PSM)比较两组患者匹配前后的临床病理特征和预后。将残胃癌变组中符合中国标准(因良性疾病行胃切除术后5年以上或胃癌行胃切除术后10年以上)的定义为A组,不符合的定义为B组,比较两组患者的临床病理特征和预后,并用Cox回归模型分析影响A组患者预后的因素。结果残胃癌变组纳入病例39例,普通胃癌组纳入病例1293例。残胃癌变组男性占比更多,老年占比更多,术前营养状况更差,预后更差,组间差异有统计学意义(P<0.05)。采用PSM后两组间预后的差异仍有统计学意义(P<0.05)。将残胃癌变组按中国标准分组后,A组纳入病例32例,B组纳入病例7例。A组男性占比更多,初次手术为良性疾病占比更多,两组间预后的差异无统计学意义(P>0.05)。Cox回归分析显示,术前CA199升高和pN3期是影响A组患者预后的独立危险因素。结论残胃癌变较普通胃癌的临床病理特征及预后明显较差,在中国标准界定下A组和B组在临床病理特征上有所差别,但两者的生存预后相类似。术前CA199升高和pN3期是A组患者预后的独立危险因素。Objective To explore the clinical pathological characteristics and prognosis of remnant gastric cancer under different definitions,as well as the prognostic factors of remnant gastric cancer under Chinese criteria.Methods A retrospective cohort study was conducted.Clinical data of patients with remnant gastric cancer(cancer on the remnant stomach)and ordinary gastric cancer treated at The Sixth Affiliated Hospital of Sun Yat-sen University from September 2008 to November 2022 were collected.Propensity score matching(PSM)was used to compare the clinical pathological characteristics and prognosis of the two groups of patients before and after matching.The patients in the remnant gastric cancer group who met the Chinese criteria(more than 5 years after gastrectomy for benign diseases or more than 10 years after gastrectomy for gastric cancer)were defined as Group A,and those who did not meet the criteria were defined as Group B.The clinical pathological characteristics and prognosis of the two groups were compared,and Cox regression analysis was used to analyze the factors affecting the prognosis of patients in Group A.Results A total of 39 cases were included in the remnant gastric cancer group and 1293 cases in the ordinary gastric cancer group.The remnant gastric cancer group had a higher proportion of males,older age,poorer preoperative nutritional status,and worse prognosis,with statistically significant differences between the groups.After PSM,the difference in prognosis between the two groups remained statistically significant.After grouping the remnant gastric cancer group according to Chinese criteria,Group A included 32 cases and Group B included 7 cases.Group A had a higher proportion of males and a higher proportion of initial surgery for benign diseases,with no statistically significant difference in prognosis between the two groups.Cox regression analysis showed that elevated preoperative CA199 and pN3 stage were independent risk factors for the prognosis of patients in Group A.Conclusion Remnant gastr

关 键 词：残胃癌 临床病理 预后 危险因素 

分 类 号：R593.23[医药卫生—内科学] R473.5[医药卫生—临床医学]