胃混合型印戒细胞癌预后影响因素分析

目的探讨印戒细胞比例低于50%的胃混合型印戒细胞癌(SRCC)的预后及其影响因素。方法回顾性分析2014年1月至2016年12月四川省资阳市第一人民医院收治的110例接受根治性胃癌切除术、且印戒细胞比例低于50%的胃混合型SRCC患者的临床资料。对患者进行随访,随访终点为全因死亡,分析SRCC患者预后的影响因素。结果中位随访时间为32.5个月(0.9~70.0个月),中位总生存(OS)时间为40.0个月(7.0~61.0个月),3年OS率为46.5%。Kaplan-Meier生存分析显示,年龄≥60岁、男性、肿瘤位于胃中上部、肿瘤最大径≥5 cm、肿瘤侵犯胃壁全层、淋巴结转移、脉管神经侵犯的胃混合型SRCC患者3年OS率分别为34.3%、31.1%、30.0%、33.3%、40.7%、28.9%、37.5%,均低于年龄<60岁、女性、肿瘤位于胃下部、肿瘤最大径<5 cm、肿瘤未侵犯胃壁全层、淋巴结未转移、未发生脉管神经侵犯的患者(57.6%、57.5%、52.9%、57.6%、56.7%、74.6%、62.3%),差异均有统计学意义(均P<0.05)。Cox多因素分析结果显示,年龄≥60岁(OR=1.225,95%CI 1.089~3.481,P=0.003)、淋巴结转移(OR=1.077,95%CI 1.059~2.674,P=0.034)、肿瘤侵犯胃壁全层(OR=1.342,95%CI 1.117~7.225,P=0.002)、脉管神经侵犯(OR=1.104,95%CI 1.087~2.541,P=0.018)是胃混合型SRCC患者OS的独立危险因素。结论高龄、淋巴结转移、侵犯胃壁全层、脉管神经侵犯的印戒细胞比例低于50%的胃混合型SRCC患者预后差。

Analysis of prognostic influencing factors of mixed signet ring cell carcinoma of the stomach

Objective To analyze the influencing factors of prognosis of early mixed signet ring cell carcinoma(SRCC)of the stomach with signet ring cell ratio less than 50%.Methods The clinical data of 110 patients with SRCC who underwent radical resection of gastric cancer in the First People's Hospital of Ziyang from January 2014 to December 2016 were retrospectively analyzed.The postoperative pathology was confirmed as mixed SRCC of the stomach with signet ring cell ratio less than 50%.The patients were followed up,and the end point of the follow-up was all-cause death.The prognostic influencing factors of SRCC patients were analyzed.Results The median follow-up time was 32.5 months(0.9-70.0 months),with the median overall survival(OS)time of 40.0 months(7.0-61.0 months)and the 3-year OS rate of 46.5%.Kaplan-Meier survival analysis showed that the 3-year OS rate of age≥60 years,male,upper stomach,tumor diameter≥5 cm,invasion of the gastric wall,lymph node metastasis,and vascular invasion of mixed SRCC of the stomach patients was 34.3%,31.1%,30.0%,33.3%,40.7%,28.9%,37.5%,respectively,which was all lower than that of those with age<60 years old,female,lower stomach,tumor diameter<5 cm,non-invasive whole stomach wall,no lymph node metastasis,no vascular invasion(57.6%,57.5%,52.9%,57.6%,56.7%,74.6%,62.3%),and there was no statistically significant difference(all P<0.05).Cox multivariate results showed that age≥60 years old(OR=1.225,95%CI 1.089-3.481,P=0.003),lymph node metastasis(OR=1.077,95%CI 1.059-2.674,P=0.034),invasion of the whole stomach wall(OR=1.342,95%CI 1.117-7.225,P=0.002),and vascular invasion(OR=1.104,95%CI 1.087-2.541,P=0.018)were independent factors affecting OS of mixed SRCC of the stomach.Conclusion Mixed SRCC of the stomach patients with signet ring cell ratio less than 50%featured by advanced age,lymph node metastasis,invasion of the full thickness of the stomach wall,and vascular invasion have a poor prognosis.