新辅助化疗增加进展期胃癌术后严重并发症  

Neoadjuvant chemotherapy increased postoperative complications of advanced gastric cancer

作　　者：金转梅 徐礼 陈敏[1] 王锐 安雨 李双喜 袁文臻[1,2] JIN Zhuanmei;XU Li;CHEN Min;WANG Rui;AN Yu;LI Shuangxi;YUAN Wenzhen(The First Clinical Medical College of Lanzhou University,Gansu Lanzhou 730000,China;The First Hospital of Lanzhou University,Gansu Lanzhou 730000,China;3942 Hospital of People's Liberation Army,Ningxia Yinchuan 750004,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院,甘肃兰州730000 [3]解放军第九四二医院,宁夏银川750004

出　　处：《现代肿瘤医学》2024年第16期3029-3037,共9页Journal of Modern Oncology

基　　金：甘肃省卫生健康行业科研计划项目(编号:GSWSKY2022-19)。

摘　　要：目的:探讨与直接手术相比,新辅助化疗后手术是否会增加进展期胃癌术后并发症发生率以及严重程度,并从身体成分、血液学变化等方面探讨其机制。方法:通过回顾性分析的方法,收集2018年1月至2021年12月在兰州大学第一医院接受新辅助化疗后行手术患者(A组)和直接手术患者(B组)的临床资料。根据Clavien-Dindo分级系统评估术后并发症的严重程度。先直接比较AB两组差异,之后通过倾向性评分匹配法(Propensity Score Matching, PSM)使两组患者基线均衡再次比较两组差异。采用χ^(2)检验、配对样本t检验、t检验比较分类或连续资料之间的关系。结果:总共纳入302例患者,并发症总发生率A组(38.4%)大于B组(30.5%),但差异无统计学意义(P>0.05)。A组较B组更易发生严重的术后并发症(P<0.05)。PSM匹配后的87对患者中,并发症总发生率A组(37.9%)大于B组(28.7%),但差异无统计学意义(P>0.05)。A组较B组更易发生严重的术后并发症(P<0.05)。同时,与B组相比,A组新辅助化疗后肌肉密度、中性粒细胞计数/淋巴细胞计数、系统性免疫炎症指数、血小板计数/淋巴细胞计数、淋巴细胞计数/单核细胞计数、预后营养指数、系统免疫炎症营养指数、血红蛋白、白蛋白、血小板均显著降低(P<0.05)。结论:进展期胃癌新辅助化疗后行手术治疗较直接手术易发生严重术后并发症,可能与新辅助化疗前后身体成分、血液学指标、营养指标及炎症指标变差相关。Objective:To investigate whether surgery after neoadjuvant chemotherapy increases the incidence and severity of postoperative complications in advanced gastric cancer compared with direct surgery,and to explore the mechanism in terms of body composition and hematological changes.Methods:Clinical data of patients undergoing surgery after neoadjuvant chemotherapy(group A)and patients undergoing direct surgery(group B)in the First Hospital of Lanzhou University from January 2018 to December 2021 were collected by retrospective analysis.The severity of postoperative complications was assessed according to the Clavien-Dindo grading system.First,the differences between the two groups were directly compared,and then the baseline of the two groups was balanced by Propensity Score Matching(PSM).Theχ^(2) test,paired sample t-test,and t-test were used to compare the relationship between classified and continuous data.Results:A total of 302 patients were included.The total incidence of complications in group A(38.4%)was higher than that in group B(30.5%),but the difference was not statistically significant(P>0.05).Group A was more likely than group B to have serious postoperative complications(P<0.05).Among the 87 pairs of PSM matched patients,the total complication rate in group A(37.9%)was higher than that in group B(28.7%),but the difference was not statistically significant(P>0.05).Group A was more likely than group B to have serious postoperative complications(P<0.05).Meanwhile,compared with group B,muscle density,neutrophil count/lymphocyte count,systemic immunoinflammatory index,platelet count/lymphocyte count,lymphocyte count/monocyte count,prognostic nutrient index,systemic immunoinflammatory nutrient index,hemoglobin,albumin,and platelet in group A after neoadjuvant chemotherapy were significantly decreased(P<0.05).Conclusion:Surgical treatment of advanced gastric cancer after neoadjuvant chemotherapy is more likely to cause serious postoperative complications than direct surgery,which may be related to the deteri

关 键 词：胃癌 新辅助化疗 胃癌根治术 术后并发症 身体成分 炎症指标 血液学指标 Clavien-Dindo分级 

分 类 号：R735.2[医药卫生—肿瘤]