食管胃结合部腺癌与胃腺癌行新辅助化疗联合胃癌根治术的临床效果及预后影响因素分析  

Clinical efficacy and prognostic factors of neoadjuvant chemotherapy and radical resection on adenocarcinoma of esophagogastric junction and gastric adenocarcinoma

作　　者：张京康 李双喜[1] 戴红梅 吴舟桥[1] 陕飞[1] 季加孚[1] 李子禹[1] Zhang Jingkang;Li Shuangxi;Dai Hongmei;Wu Zhouqiao;Shan Fei;Ji Jiafu;Li Ziyu(Department of Gastrointestinal Surgery,Peking University Cancer Hospital&Institute,Beijing Institute for Cancer Research,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心、恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中华消化外科杂志》2025年第3期357-366,共10页Chinese Journal of Digestive Surgery

基　　金：中国医学基金会项目(2020064);北京市属医学科研院所公益发展改革试点项目(JYY2023‑3)。

摘　　要：目的探讨食管胃结合部腺癌(AEG)与胃腺癌行新辅助化疗联合胃癌根治术的临床效果及预后影响因素。方法采用倾向评分匹配及回顾性队列研究方法。收集2017年3月至2022年3月北京大学肿瘤医院收治的263例AEG及胃腺癌患者的临床病理资料;男204例,女59例;年龄为(60±10)岁。263例患者中,81例AEG设为AEG组;182例胃腺癌设为胃腺癌组。观察指标:(1)倾向评分匹配情况及匹配后两组患者临床病理特征比较。(2)新辅助化疗效果评估及病理学情况。(3)术中及术后情况。(4)随访情况。(5)患者预后的影响因素分析。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秩和检验;计数资料组间比较采用χ^(2)检验。等级资料组间比较采用非参数秩和检验。采用Cox比例风险模型进行单因素和多因素分析。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。倾向评分匹配按1∶1最近邻匹配法匹配,卡钳值为0.02。结果(1)倾向评分匹配情况及匹配后两组患者临床病理特征比较。263例患者中,156例匹配成功,AEG组和胃腺癌组各78例。倾向评分匹配后,消除匹配前年龄、肿瘤分化程度因素混杂偏倚,具有可比性。(2)新辅助化疗效果评估及病理学情况。倾向评分匹配后,AEG组和胃腺癌组患者病理学完全缓解分别为2例和9例,两组比较,差异有统计学意义(χ^(2)=4.793,P<0.05)。(3)术中及术后情况。倾向评分匹配后,AEG组和胃腺癌组患者手术时间,切除范围(全胃、远端胃、近端胃),消化道重建方式(Roux‑en‑Y、Billroth Ⅰ/Ⅱ/Uncut Roux‑en‑Y、食管残胃、双通路),术后住院时间,总住院费用分别为225(200,283)min,68、0、10例,68、0、5、5例,12(10,16)d,(114400±4828)元和200(174,234)min,22、55、1例,21、56、0、1例,10(9,11)d,(98790±2549)元,两组患者上述指标比较,差异均�Objective To investigate the clinical efficacy and prognostic factors of neoadjuvant chemotherapy(NACT)and radical resection on adenocarcinoma of esophagogastric junction(AEG)and gastric adenocarcinoma(GC).Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 263 patients with AEG and GC who were admitted to Peking University Cancer Hospital from March 2017 to March 2022 were collected.There were 204 males and 59 females,aged(60±10)years.Of the 263 patients,81 cases with AEG were set as the AEG group,and 182 cases with GC were set as the GC group.Observation indicators:(1)propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching;(2)evaluation of the efficacy of NACT and pathological conditions;(3)intraoperative and postoperative conditions;(4)follow-up;(5)analysis of factors affecting prognosis of patients.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 rank sum test.Comparison of count data between groups was conducted using the chi-square test.Comparison of ordinal data between groups was conducted using the nonparametric rank sum test.The Cox proportional hazard model was used for univariate and multivariate analyses.The Kaplan-Meier method was used to calculate survival rate and draw survival curve.The Log-rank test was used for survival analysis.Propensity score matching was done by the 1:1 nearest neighbor matching method with a caliper value of 0.02.Results(1)Propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching.Of 263 patients,156 cases were successfully matched,including 78 cases in the AEG group and 78 cases in the GC group.After propensity score matching,the elimination of age and degree of tumor differentiation confou

关 键 词：食管胃结合部腺癌 胃腺癌 新辅助化疗 临床疗效 并发症 预后 

分 类 号：R735.2[医药卫生—肿瘤]