肿瘤间质比在胃癌术后患者预后评估中的价值

李松岩; 刘帛岩; 杨宇; 滕达; 胡时栋; 林海冠; 杜晓辉

doi:10.3969/j.issn.2095-5227.2021.08.006

肿瘤间质比在胃癌术后患者预后评估中的价值

Prognostic value of tumor stroma ratio in patients with gastric cancer

摘要

摘要:
背景肿瘤间质比被证明是多种不同肿瘤新的预后因子，其在胃癌中的预测价值尚不明确。
目的评价肿瘤间质比在胃癌患者预后评估中的价值。
方法收集2016年1月- 2017年1月于解放军总医院第一学中心接受胃切除术的胃癌患者的临床和组织病理学资料，以50%的肿瘤间质比为界，将患者分为低间质比组(＜50%)和高间质比组(≥ 50%)，比较两组病理结果、生存期的差异。
结果 115例患者中，高间质比组53例，低间质比组62例。低间质比的患者T3/T4局部侵袭率高(64.5% vs 39.6%，P=0.008)，N2/N3占比高(54.8% vs 2.4%，P=0.008)，TNM分期高(33.9% vs 15.1%，P=0.021)。低间质比组患者表现出较高比例的淋巴血管浸润(51.6% vs 24.5%，P=0.003)和神经浸润(72.6% vs 54.7%，P=0.046)。与高间质比组相比，低间质比组的3年总生存(overall survival，OS)率(70.0% vs 24.0%, P＜0.001)和无病生存(disease-free survival，DFS)率(62.0% vs 20.0%， P＜0.001)明显较低。多因素分析显示，低肿瘤间质比(OS: HR=0.281，95% CI=0.138～0.574；DFS: HR=0.289，95% CI=0.170～0.489)、高TNM分期(OS: HR=0.192, 95% CI=0.087～0.426；DFS: HR=0.223, 95% CI=0.130～0.382)以及神经侵犯（OS: HR=0.407, 95% CI=0.233～0.710；DFS: HR=0.526, 95% CI=0.325～0.852）是影响OS、DFS的独立危险因素。
结论低肿瘤间质比是胃癌患者预后不良的独立危险因素，建议纳入常规临床病理报告，可为评估预后提供参考。

Abstract:
Background Tumor-stromal ratio has been proved to be a new prognostic factor for many different tumors, and its predictive value in gastric cancer needs to be evaluated.
Objective To evaluate the prognostic value of tumor-stromal ratio in patients with gastric cancer.
Methods From January 2016 to January 2017, clinical and histopathological data of patients with gastric cancer who underwent gastrectomy in the First Medical Center of Chinese PLA General Hospital were collected. Using tumor stroma ratio (50%) as the cut-off value, the patients were divided into stroma sparse group (＜50%) and stroma-rich group (≥ 50%). The histopathological results and survival were compared between the two groups.
Results There were 115 cases in total, and 53 cases were in the high TSR group and 62 cases in the low TSR group. The patients in the low TSR group had higher local invasion rate of T3/T4 (64.5% vs 39.6%, P=0.008), higher proportion of N2/N3 (54.8% vs 2.4%, P=0.008) and higher TNM stage (33.9% vs 15.1%, P=0.021). Patients in the low TSR group showed a higher proportion of lymphatic vascular infiltration (51.6% vs 24.5%, P=0.003) and nerve infiltration (72.6% vs 54.7%, P=0.046). Compared with patients in the high TSR group, the 3-year overall survival rate (70.0% vs 24.0%, P＜0.001) and disease-free survival rate (62.0% vs 20.0%, P＜0.001) of patients in the low TSR group were significantly lower. Cox proportional hazards regression analysis showed that poor tumor stroma ratio (OS: HR=0.281, 95% CI=0.138 - 0.574; DFS: HR=0.289, 95% CI=0.170-0.489), high TNM stage (OS: HR=0.192, 95% CI=0.087-0.426; DFS: HR=0.223, 95% CI=0.130-0.382) and neuronal invasion (OS: HR=0.407, 95% CI=0.233 - 0.710; DFS: HR=0.526, 95% CI=0.325 - 0.852) were independent risk factors for OS and DFS.
Conclusion Low tumor stroma ratio is an independent risk factor for poor prognosis of patients with gastric cancer. It is suggested that it should be included in routine clinicopathological reports, which can provide important reference information for postoperative follow-up and treatment.

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