胃癌术后早期复发影响因素及预后分析的全国多中心研究  

Influencing factors and prognostic analysis of early recurrence after gastrectomy for gastric cancer:a national multicenter study

作　　者：陆俊 吕陈彬 曹毅[3] 陈杰[1] 李森 蔡丽生 王栓虎[5] 丁方回 李正荣[3] 赵玉洲[4] 刘凤林 Lu Jun;Lyu Chenbin;Cao Yi;Chen Jie;Li Sen;Cai Lisheng;Wang Shuanhu;Ding Fanghui;Li Zhengrong;Zhao Yuzhou;Liu Fenglin(Second Department of Gastric Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Gastric Surgery,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,China;Department of Gastrointestinal Surgery,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of General Surgery,Henan Cancer Hospital,Zhengzhou 450008,China;Department of Gastrointestinal Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]复旦大学附属肿瘤医院胃外二科,上海200032 [2]福建医科大学附属漳州市医院胃外科,漳州363000 [3]南昌大学第一附属医院胃肠外科,南昌330006 [4]河南省肿瘤医院普通外科,郑州450008 [5]蚌埠医学院第一附属医院胃肠外科,蚌埠233004 [6]兰州大学第一医院普通外科,兰州730030

出　　处：《中华消化外科杂志》2025年第3期350-356,共7页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82373381)。

摘　　要：目的探讨胃癌术后早期复发的影响因素及预后情况。方法采用回顾性队列研究方法。收集2012年1月至2023年6月复旦大学附属肿瘤医院等全国6家医学中心收治的2078例行胃癌切除术患者的临床病理资料;男1449例,女629例;年龄为(59±11)岁。根据患者术后肿瘤复发时间,分为早期和晚期复发。观察指标:(1)不同复发类型胃癌患者临床病理特征比较。(2)复发转移情况。(3)胃癌术后复发患者生存情况。(4)胃癌术后早期复发的影响因素分析。正态分布的计量资料组间比较采用独立样本t检验,偏态分布的计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ^(2)检验。等级资料组间比较采用秩和检验。采用Logistic回归模型进行多因素分析。采用Kaplan-Meier法计算生存率并绘制生存曲线,Log-rank检验进行生存分析。结果(1)不同复发类型胃癌患者临床病理特征比较。2078例患者中,早期复发1452例、晚期复发626例。早期和晚期复发患者术前癌胚抗原、术前CA19-9、术前CA72-4、术前白蛋白、肿瘤长径、新辅助治疗、R0切除、联合脏器切除、胃切除范围、神经脉管浸润、肿瘤分化程度、病理学N分期、病理学TNM分期比较,差异均有统计学意义(P<0.05)。(2)复发转移情况。2078例患者中,局部复发200例、血行转移1213例、远处淋巴结转移392例、腹膜转移731例。1452例早期复发患者中,局部复发142例、血行转移834例、远处淋巴结转移289例、腹膜转移507例;626例晚期复发患者中,局部复发58例、血行转移379例、远处淋巴结转移103例、腹膜转移224例;同1例患者可合并多种形式的复发、转移,早期与晚期复发患者上述指标比较,差异均无统计学意义(χ^(2)=0.13、1.74、3.40、0.14,P>0.05)。(3)胃癌术后复发患者生存情况。2078例患者均随访至复发后死亡,随访时间为31(9~147)个月。早期复发患者复发后1、2�Objective To investigate the influencing factors and prognosis of early recurrence after gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 2078 patients who underwent gastrectomy for gastric cancer at six medical centers across China,including Fudan University Shanghai Cancer Center et al,between January 2012 and June 2023 were collected.There were 1449 males and 629 females,aged(59±11)years.Patients were classified as early recurrence and late recurrence based on the time of post-operative recurrence.Observation indicators:(1)comparison of clinicopathological characteristics between gastric cancer patients with different recurrence types;(2)recurrence and metastasis of tumor;(3)survival of patients after postoperative recurrence of gastric cancer;(4)analysis of influencing factors for early recurrence after gastrectomy for gastric cancer.Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test.Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test.Comparison of count data between groups was conducted using the chi-square test.Comparison of ordinal data between groups was conducted using the rank sum test.Multivariate analysis was conducted using the Logistic regression model.Kaplan-Meier method was used to calculate survival rate and plot survival curve,and Log-rank test was used for survival analysis.Results(1)Comparison of clinicopathological characteristics between gastric cancer patients with different recurrence types.Among the 2078 patients,1452 cases had early recurrence and 626 cases had late recurrence.There were significant differences in preoperative carcinoembryonic antigen,preoperative CA19-9,preoperative CA72-4,preoperative albumin,tumor diameter,neoadjuvant therapy,R0 resection,combined organ resection,scope of gastric resection,nerve and vessel infiltration,degree of tumor differentiation,pathological N stagi

关 键 词：胃肿瘤 胃切除术 术后复发 复发时间 复发部位 随访 预后 

分 类 号：R735.2[医药卫生—肿瘤]