| 胃癌根治术后切缘阳性患者的临床病理特征和预后分析 |
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| 引用本文： | 高歌,张志栋,贾楠,王志新,王冬,李芳,赵群,范立侨,李勇. 胃癌根治术后切缘阳性患者的临床病理特征和预后分析[J]. 中国肿瘤临床, 2022, 49(5): 237-243. DOI: 10.12354/j.issn.1000-8179.2022.20211705 |
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| 作者姓名： | 高歌 张志栋 贾楠 王志新 王冬 李芳 赵群 范立侨 李勇 |
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| 作者单位： | 1.河北医科大学第四医院外三科（石家庄市050011） |
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| 基金项目： | 本文课题受河北省高等学校科学技术研究项目（编号:ZD2019139）和河北卫健委县级公立医院适宜卫生技术推广入库项目（编号:2019024）资助 |
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| 摘 要： | 目的 探讨胃癌根治术后切缘阳性患者的临床病理特征及其对预后影响。 方法 回顾性分析河北医科大学第四医院2011年1月至2016年1月收治的胃癌根治术后切缘阳性患者的临床病理资料。按1∶2随机数法选取同期收治的切缘阴性患者，比较阳性和阴性切缘患者的一般临床病理学特征及预后情况。 结果 共纳入73例切缘阳性患者，与同期纳入的146例切缘阴性病例比较，阳性组的肿瘤直径更大、更多位于贲门或全胃，组织学类型更差、Lauren分型趋于弥漫型、Borrmann分型多为Ⅲ～Ⅳ型、肿瘤浸润深度以T4a～4b为主、pTNM分期更晚，脉管浸润率及淋巴结转移率也更高，同时术者经验、手术方式的差异也与阳性切缘发生有关（均P<0.05）。全组共有205例患者获得完整随访，两组患者5年总生存（overall survival，OS）率及无进展生存（progression-free survival，PFS）率均有显著性差异（23.19% vs. 58.82%，15.94% vs. 47.06%，均P<0.001）。Cox多因素分析显示，切缘状态（P=0.012）、pTNM分期（P=0.023）及术后综合治疗（化疗/化疗联合放疗）（P<0.001）是影响胃癌预后的独立因素。 结论 胃癌根治术后切缘状态与多种临床病理特征相关，切缘阳性患者预后较差。
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| 关 键 词： | 胃癌 根治术 切缘阳性 危险因素 预后分析 |
| 收稿时间： | 2021-11-14 |
Clinicopathological characteristics and prognostic analysis of gastric cancer patientswith positive resection margin after radical surgery |
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| Affiliation: | 1.The Third Department of Surgery2.Departmentof Pathology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China |
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| Abstract: | Objective To investigate the clinicopathological characteristics of patients with positive resection margin after radical surgery for gastric cancer and the impact of positive margin on prognosis. Methods We retrospectively collected the clinicopathological data of gastric cancer patients with positive resection margins admitted to Fourth Hospital of Hebei Medical University for radical gastrectomy from January 2011 to January 2016. Patients with negative resection margins admitted at the same period were selected using the random number method (ratio, 2∶1), and the general clinicopathological characteristics and prognosis of patients with positive and negative margins were compared. Results In total, 73 patients with positive resection margins and 146 with negative resection margins were included. Compared to patients with negative margins, those with positive margins had larger tumor sizes, greater number of tumors in the cardia or whole stomach, worse histological types, advanced tumor pTNM stages, and higher rates of vascular invasion and lymph node metastasis; their Lauren type tended to be diffuse, Borrmann type tended to be types Ⅲ–Ⅳ, and tumor invasion depth mostly T4a-4b. The difference in operative experience and surgical methods was also associated with positive margin (all P<0.05). A total of 205 patients were followed up completely. There were significant differences in 5-year overall survival (OS) and progression-free survival (PFS) between the two groups (23.19% vs. 58.82%, 15.94% vs. 47.06%, all P<0.001). Cox multivariate analysis showed that the resection margin status (P=0.012), tumor pTNM stage (P=0.023), and postoperative comprehensive treatment (chemotherapy/chemoradiotherapy, P<0.001) were independent factors for the prognosis of gastriccancer. Conclusions The resection margin status after radical gastric cancer is related to various clinicopathological characteristics, and patients with positive margins have a poor prognosis. |
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