| 胃上部癌患者的临床病理特点及预后分析 |
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| 引用本文： | 周潮平,马军,蒋鹏,朱磊,张亚铭. 胃上部癌患者的临床病理特点及预后分析[J]. 中国肿瘤临床, 2022, 49(4): 184-187. DOI: 10.12354/j.issn.1000-8179.2022.20210934 |
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| 作者姓名： | 周潮平 马军 蒋鹏 朱磊 张亚铭 |
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| 作者单位： | 安庆市立医院肿瘤外科 （安徽省安庆市246000） |
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| 摘 要： | 目的 研究胃上部癌患者N05.6组淋巴结转移情况，探讨患者的临床病理特点及预后，分析影响患者预后的相关因素，为胃上部癌患者的合理术式提供理论依据。 方法 : 回顾性分析2010年9月至2015年6月安庆市立医院肿瘤收治的231例胃上部癌患者的临床病理资料，根据患者术后病理结果，计算出N05.6组淋巴结转移情况。采用门诊及电话方式进行随访，截止至2018年6月。计数资料间的比较采用χ2检验。Kaplan-Meier法绘制生存曲线，Log-rank检验进行生存分析及单因素分析。Cox回归进行多因素分析。 结果 231例胃上部癌患者中，平均淋巴结清扫数目为18.60（4 297/231）枚，N05.6组淋巴结转移率为8.23%（19/231），患者的不同N分期、TNM分期的N05.6组淋巴结转移情况进行比较，差异具有统计学意义（χ2=14.219，13.171；P<0.05）。2例患者失访，随访率为99.13%（229/231），随访时间4～94个月，中位随访时间49个月，总体5年累积生存率70.30%。N05.6组淋巴结阳性的患者，中位生存时间为42个月，5年累积生存率48.6%；阴性的患者，中位生存时间为50个月，5年累积生存率71.9%，两者的比较差异具有统计学意义（χ2=6.175，P<0.05）。单因素分析结果显示，肿瘤分化程度、N分期、TNM分期、N05.6组淋巴结转移情况是影响患者预后的相关因素（χ2=4.583，28.224，9.136，6.175；P<0.05）。多因素分析结果显示，N分期是胃上部癌患者预后的独立危险因素（HR=0.096，95%CI:0.027～0.341，P<0.05）。 结论 : 胃上部癌患者的淋巴结转移数目为预后的独立危险因素，对于T1、T2期无远处转移的胃上部癌患者可考虑行近端胃切除术。
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| 关 键 词： | 胃癌 淋巴结转移 预后 |
| 收稿时间： | 2021-06-21 |
Analysis of clinicopathological characteristics and prognosis among patients with upper gastric cancer |
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| Affiliation: | Department of Oncological Surgery, Anqing Municipal Hospital, Anqing 246000, China |
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| Abstract: | Objective: To evaluate N05.6 group lymph node metastasis, describe the clinicopathological characteristics and prognosis, and analyze factors affecting the prognosis of patients with upper gastric cancer, in order to provide a theoretical basis for the surgical method used to treat patients with upper gastric cancer. Method: Clinicopathological data of 231 patients with upper gastric cancer who were admitted to Anqing Municipal Hospital from September 2010 to June 2015 were analyzed retrospectively. According to postoperative pathologic results, the lymph node metastasis rate of the N05.6 group was calculated. All the patients were followed up via outpatient examination and telephone interview up to June 2018. The count data were analyzed using the chi-square test. The survival curve was drawn using the Kaplan-Meier method. The survival ana1ysis and univariate analysis were performed using the Log-rank test, and multivariate analysis was performed using the Cox regression model. Results : The mean number of dissected lymph nodes was 18.60 (4, 297/231) . The N05.6 group lymph node metastasis rate among the 231 patients was 8.23% (19/231). The N stage and TNM stage in all patients were compared, showing significant differences (χ2=14.219, 13.171; P<0.05). A total of 229 patients were followed up for (4-94) months [median, 49 months; follow-up rate: 99.13% (229/231)], and the 5-year cumulative survival rate was 70.3%. The median survival time and 5-year cumulative survival rate in patients with positive and negative N05.6 group lymph node were 42 months and 48.6% and, 50 months and 71.9%, respectively, with a significant difference noted in the survival of patients (χ2=6.175, P<0.05). The results of univariate analysis showed that the tumor differentiation, N stage, TNM stage and the N05.6 group lymph node metastasis were factors affecting the prognosis of patients with upper gastric cancer (χ2=4.583, 28.224, 9.136, 6.175; P<0.05). The results of multivariate analysis showed that the N stage was an independent risk factor affecting the prognosis of patients with upper gastric cancer (HR=0.096, 95%CIl: 0.027-0.341, P<0.05). Conclusions : N stage was an independent risk factor affecting the prognosis of patients with upper gastric cancer, therefore, the proximal gastrectomy may be performed in patients with T1 and T2 stage disease with no distant metastasis as therapy for upper gastric cancer. |
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