基于癌结节状态及复发模式改良Ⅱ/Ⅲ期胃癌患者根治术后随访计划的研究  

Improving a follow-up plan based on the tumor deposits status and recurrence pattern of stageⅡ/Ⅲgastric cancer patients after radical gastrectomy

作　　者：华科雷 霍明科 董志闯 李森 张贺 任莹坤 曹轶 Hua Kelei;Huo Mingke;Dong Zhichuang;Li Sen;Zhang He;Ren Yingkun;Cao Yi(Department of General Surgery,He′nan Cancer Hospital,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Pathology,He′nan Cancer Hospital,Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,China;School of Public Health,North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]郑州大学附属肿瘤医院、河南省肿瘤医院普外科,郑州450008 [2]郑州大学附属肿瘤医院、河南省肿瘤医院病理科,郑州450008 [3]华北理工大学公共卫生学院,唐山063000

出　　处：《中华普通外科杂志》2024年第10期783-789,共7页Chinese Journal of General Surgery

摘　　要：目的探讨Ⅱ/Ⅲ期胃癌患者根治性切除术后癌结节状态与复发模式之间的关系,并对癌结节阳性患者制定个性化随访计划。方法回顾性分析2015年9月至2018年9月在河南省肿瘤医院接受根治性手术的706例Ⅱ/Ⅲ期胃癌患者,根据其癌结节状态将患者分为癌结节阳性组(TDs+112例)和癌结节阴性组(TDs-594例),比较两组患者的临床病理特征和复发模式,并得到改良后的随访计划。结果TDs-组患者的1、3年总生存率和无病生存率均高于TDs+组(92.4%、72.2%比79.4%、38.8%;87.9%、68.6%比66.7%、35.9%),差异均有统计学意义(均P<0.05)。TDs+组和TDs-组腹膜转移率分别33.0%、14.5%,远处转移率分别为21.4%、10.8%,差异均有统计学意义(χ^(2)=21.285、8.851,均P<0.05)。TDs+组患者远处转移的中位时间明显早于TDs-组,差异有统计学意义(9.0个月比15.4个月,Z=-2.294,P=0.022)。TDs+组腹膜转移复发风险高于TDs-,并且呈现双复发峰,复发高峰分别在术后8.5个月和15.0个月。TDs+组远处转移复发风险高于TDs-组,在6个月时出现单复发高峰。结论TDs+和TDs-患者术后的复发模式有差异,改良后的随访计划可提高复发的早期检出率。Objective To investigate the relationship between cancer node status identified after radical resection and patterns of recurrence in stageⅡ/Ⅲgastric cancer patients for developing personalized follow-up plans in node-positive patients.Methods A retrospective analysis was conducted on 706 stageⅡ/Ⅲgastric cancer patients who underwent curative intent surgery at Henan Cancer Hospital from Sep 2015 to Sep 2018.Patients were categorized into node-positive(TDs+)and node-negative(TDs-)groups based on their cancer node status.Clinical-pathological characteristics and recurrence patterns were compared between the groups to formulate an optimized follow-up plan.Results Among the patients,there were 112 TDs+and 594 TDs-cases.TDs-patients exhibited significantly better overall survival and disease-free survival rates at 1 and 3 years compared to the TDs+group(92.4%,72.2%vs.79.4%,38.8%;87.9%,68.6%vs.66.7%,35.9%,all P<0.05).The cumulative recurrence rates of peritoneal and distant metastases were higher in TDs+patients compared to TDs-patients,with statistical significance(33.0%vs.14.5%,21.4%vs.10.8%,χ^(2)=21.285,8.851 all P<0.05).TDs+patients experienced significantly earlier median time to distant metastasis compared to TDs-patients(9.0 months vs.15.4 months,Z=-2.294 P=0.022).The risk of peritoneal metastasis recurrence was higher in the TDs+group,showing a bimodal recurrence pattern at 8.5 and 15.0 months post-surgery.TDs+patients also had a higher risk of distant metastasis recurrence,with a single peak at 6 months.Conclusion Postoperative recurrence patterns differ between TDs+and TDs-patients,and an optimized follow-up plan can enhance early detection of recurrence.

关 键 词：胃肿瘤 复发 随访研究 癌结节 

分 类 号：R735.2[医药卫生—肿瘤]