Ⅰ~Ⅲ期胃癌术后影响预后的相关因素分析

Associated factors influencing prognosis of stageⅠ-Ⅲ gastric cancer after operation

  • 摘要: 目的 总结接受根治性手术的Ⅰ~Ⅲ期胃癌病例的临床病理特点,术后治疗特点及生存规律。 方法 回顾性分析2003年1月-2008年12月在我院行胃癌根治术且随访资料完整的Ⅰ~Ⅲ期病例827例,分析其临床病理特征、治疗特点与生存预后的关系。 结果 827例中位随访期58.2个月,出现复发或转移507例,死亡457例,中位无疾病生存期为26.6个月,中位生存期为39.7个月;5年无疾病生存率和总生存率为37.9%和43.8%。单因素分析示:全胃切除、切缘阳性、含印戒细胞癌、Lauren分型弥漫型及混合型、低/中低分化、脉管癌栓、神经浸润、肿瘤直径≥5 cm、肿瘤淋巴结转移(tumor lymph node metastasis,TNM)分期晚及未行辅助化疗者较胃部分切除、切缘阴性、不含印戒细胞癌、Lauren分型肠型、中/中高/高分化、无脉管癌栓、无神经浸润、肿瘤直径< 5 cm、TNM分期较早及接受辅助化疗者的中位无疾病生存期和中位生存期显著缩短(P< 0.05)。COX多因素生存分析提示:是否全胃切除、切缘是否阳性、是否辅助化疗、TNM分期均是无疾病生存期和总生存期的独立预后因素。 结论 辅助化疗可显著改善胃癌术后患者的无疾病生存期和总生存期。

     

    Abstract: Objective To summarize the clinicopathologic features of patients with gastric cancer at stage I-III and their treatment and survival rules after operation. Methods Clinical data about 827 patients with gastric cancer at stage I-III admitted to our hospital from January 2003 to December 2008 for radical surgery were retrospectively analyzed. Relation of their clinicopathologic features and treatment with their survival time and prognosis was also analyzed. Results Of the 827 patients who were followed up for 58.2 months, 507 developed recurrence or metastasis of gastric cancer and 457 died. The median disease-free survival time was 26.6 months and the median survival time was 39.7 months. The 5-year disease-free survival rate was 37.9% and the overall survival rate was 43.8%. Univariate analysis showed that the disease–free survival time and the median survival time were significantly shorter in patients with positive surgical margin, signet ring cell cancer, Lauren diffuse and mixed type, poor and moderate differentiation, vessel cancer embolus, neural cell infiltration, tumor diameter≥5 cm, late TNM stage and non-adjuvant chemotherapy after total gastrectomy than in those with negative surgical margin, no signet ring cell cancer, Lauren intestinal peristalsis, moderate and high differentiation, no vessel cancer embolus, no neural cell infiltration, tumor diameter< 5 cm, early TNM stage, and adjuvant chemotherapy after gastrectomy (P< 0.05). Multivariate COX regression analysis displayed that total gastrectomy, positive surgical margin, adjuvant chemotherapy, TNM stage were the independent factors for the prognosis of disease-free and overall survival time of gastric cancer patients. Conclusion Adjuvant chemotherapy can increase the disease-free and overall survival time of gastric cancer patients after operation.

     

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