青年胃癌患者的临床病理特征及预后分析

目的:研究青年(≤35岁)胃癌患者的临床病理特征和预后的影响因素。方法:回顾性收集湖南省肿瘤医院2010年10月至2017年12月行根治性切除的2029例Ⅰ-Ⅲ期胃癌患者的临床病理资料,根据患者首次确诊时年龄大小分为青年组(n=75)和对照组(n=1954)。对比两组患者的一般状况、病理结果和长期生存等,采用χ²或t检验分别对比分析分类变量和连续变量,Kaplan-Meier法、Log-rank检验及Cox回归多因素分析预后影响因素。结果:青年组胃癌患者的平均年龄为30.13岁(19~35)岁,其中53.3%为女性。与对照组相比,青年组患者中女性患者的比例更高,术前白蛋白水平更高,全身合并症的发生率及术后并发症的发生率更低,术后住院时间更短,而接受新辅助化疗和辅助化疗的比例更高(均P<0.05)。青年组和对照组术后1、3和5年生存率没有统计学差异(94.6%、60.1%、54.2%vs 89.3%、67.7%、58.1%,P=0.601)。进一步Cox回归多因素分析显示,肿瘤病理分期是影响青年胃癌患者术后生存的主要因素。结论:青年胃癌患者以女性更为常见,早期发现,行根治性切除以后,接受辅助化疗等治疗,其预后与中老年患者相当。     

新疆306例老年胃癌患者临床病理特征及预后分析

目的：探讨老年胃癌的临床病理特点及影响预后的相关因素。方法：回顾性分析306例老年胃癌患者临床病理资料,采用Kaplan-meier法计算患者的生存率,Log-rank检验进行单因素分析,Cox多因素回归分析与胃癌相关指标的预后意义。结果：随访的306胃癌患者中,存活123例,死亡183例,1、3、5年总体生存率分别为78.9％、43.2％、28.6％;单因素分析显示年龄、性别、民族、合并症、组织学分级、浸润深度、脉管及神经受侵、淋巴结转移、远处转移、肿瘤标志物与胃癌的预后相关（ P＜0.05）;吸烟史、肿瘤家族史、幽门螺杆菌（Hp）感染史、肿瘤部位、甲胎蛋白（AFP）与胃癌的预后无显著影响（P＞0.05）。Cox多因素分析结果显示年龄、合并症、饮酒史、脉管侵犯、浸润深度、淋巴结转移、pTNM分期、根治性手术是影响胃癌预后的独立危险因素。结论：年龄、合并症、饮酒史、脉管侵犯、浸润深度、淋巴结转移、pTNM分期、根治性手术是影响老年胃癌预后的独立危险因素;而pTNM分期反映肿瘤的生物学特性和进展状况,临床应用价值较高。     

中青年与老年胃癌术后患者的临床病理特点和预后因素—基于SEER数据库的分析

目的:比较中青年与老年胃癌患者的临床病理特征,分析胃癌根治术后影响中青年和老年胃癌患者长期生存的预后因素。方法:选取SEER数据库经胃癌根治手术治疗后的胃癌患者,用方差分析分析胃癌不同原发部位的肿瘤大小差异,采取COX比例风险模型、卡方检验和Kaplan-meier法,对患者资料进行分析。结果:两组胃癌患者在性别、组织学类型、T分期、分化程度、婚姻情况等方面比较,差异均有统计学意义（P＜0.05）。与老年胃癌组相比,中青年胃癌组中男性发生率高,出现印戒细胞癌的比例高,且低分化或未分化所占比例都高于老年胃癌组。年龄是影响胃癌根治术后患者生存期的独立危险因素。种族、肿瘤原发部位、T、N、M分期、肿瘤大小均是影响中青年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响中青年胃癌患者生存期的独立危险因素（P＜0.05）。种族、肿瘤原发部位、分化程度、组织学类型、T、N、M分期、肿瘤大小、婚姻情况均是影响老年胃癌患者生存时间的相关因素（P＜0.05）,肿瘤大小、T、N、M分期是影响老年胃癌患者生存期的独立危险因素（P＜0.05）。胃癌不同原发部位的肿瘤大小之间的差异无统计学意义（P＞0.05）。结论:年龄与胃癌的临床病理特征关系密切,不同年龄具有不同发病特点,且年龄是影响胃癌根治术后患者生存期的独立危险因素。淋巴结的转移度、肿瘤的侵犯深度、肿瘤的大小、远处转移均是中青年和老年胃癌患者预后的重要因素,强调早诊早治,是提高胃癌患者预后的关键。     

65例可切除老年胃癌临床病理特征和预后分析

目的:分析65例可切除老年胃癌患者的临床病理特征和预后。方法:回顾性分析病理证实的65例年龄≥65岁老年可切除胃癌患者的临床病理特征和预后。60例(92.3%)患者行R0切除。62例(95.4%)患者行D2术。18例(27.7%)患者行术后辅助化疗。Kaplan-Meier法分析生存率,Log-rank检验比较组间生存差异。结果:65例患者中,男49例,女16例。60例(92.3%)患者为腺癌。TNM分期为I-II和III期患者分别为15例(23.1%)和50例(76.9%)。32例(49.2%)患者伴有合并症,6例(9.2%)伴有1个以上合并症。全组患者2年总生存率(overall survival,OS)、无进展生存率(progression-free survival,PFS)和癌症特异生存率(cancer-specific survival,CSS)分别为42.6%、28.4%和49.0%。单因素分析发现,N0-1患者的预后明显优于N2-3的患者,2年OS、PFS和CSS分别为77.9%和31.6%(P=0.010)、78.6%和16.3%(P=0.002)以及83.1%和37.3%(P=0.023)。死亡原因分析发现,33例死亡患者中,肿瘤相关死亡25例(75.8%),治疗相关或合并症相关死亡8例(24.2%)。结论:可切除老年胃癌的合并症多见,治疗相关或合并症相关死亡多见,N分期是最重要的临床预后因素。     

青年与老年肺癌患者临床特征及其治疗与预后的差异性研究

目的：探讨青年肺癌与老年肺癌患者在临床病理特征及其治疗预后上的差异性。方法：回顾性分析我院2000年至2008年期间95例肺癌患者病理资料，包括青年肺癌45例，老年肺癌50例，分析比较两组在临床病理特征及其治疗与预后上的差异性。结果：年龄小于40岁的青年所患肺癌更倾向于腺癌（29/45，64.4%）、低分化（19/45，42.2%）以及Ⅲ＋Ⅳ期（25/45，55.6%）肺癌。而老年患者则更倾向于鳞癌和腺癌（45/50，90.0%）、中高分化（41/50，82.0%）以及Ⅰ＋Ⅱ期（34/50，68.0%）肺癌，差异均具有统计学意义。而在性别与吸烟史上所表现的差异性无统计学意义。青年肺癌更易于接受手术加术后放化疗治疗的综合治疗（38/45，84.4%），手术率明显高于老年患者，差异具有统计学意义。在预后生存分析中青年肺癌在1、3、5年的生存率（64.34%、30.45%、14.35%）稍高于老年肺癌患者（62.76%、27.26%、11.78%），且差异具有统计学意义。结论：对老年肺癌患者应强调其综合治疗的满意度，而对于青年肺癌患者，更应着重早期发现、早诊断、早治疗。     

胃癌根治术预后临床病理因素分析

回顾性分析了３９０例胃癌行根治性切除术后的病例，通过对临床病理指标的单因素和多因素Ｃｏｘ回归分析，研究诸因素影响预后的作用程度。结果：本组３－ＹＳＲ、５－ＹＳＲ分别为５５．４％、４０．３％，手术死亡率为３．６％。肿瘤浸润深度、淋巴结阳性数、肿瘤大小和根治程度是影响术后生存率的独立性因素。与预后相关性因素包括：年龄、组织类型、解剖部位和淋巴结转移程度。其它因素与预后无明显相关性。     

160 例胃癌根治术后预后分析*

目的：探讨胃癌根治术后影响患者长期生存的预后因素。方法：回顾性分析天津医科大学附属肿瘤医院2001年1 月至2002年12月收治并行胃癌根治术的患者,将数据输入SPSS13.0 统计软件,通过比较1、3、5 年生存率分析各项可能影响胃癌预后的因素。结果：全组病例1、3、5 年生存率分别为72.50% 、52.50% 、45.00% 。单因素分析显示,年龄、手术方式、肿瘤最大径、Borrmann 分型、联合脏器切除、肿瘤侵犯深度、淋巴结转移度以及临床分期与术后远期生存有关（P<0.05）。 而多因素分析显示,仅患者年龄、手术方式、肿瘤侵犯深度以及临床分期是胃癌根治术后患者预后的独立因素（P<0.05）。 结论：患者年龄、手术方式、肿瘤侵犯深度以及临床分期是影响胃癌根治术后患者预后的重要因素。     

青年胃癌28例临床分析

对28例青年人胃癌进行临床分析，发现青年胃癌误诊率高达82．1％。误诊的主要原因是胃癌早期无特异性及首诊医生偏重胃癌的老年因素。     

乳腺癌临床特征与预后分析

目的：总结经综合治疗的233例乳腺癌患者的临床病理特征及生存情况,探讨影响乳腺癌预后的因素。方法：建立乳腺癌患者的临床资料库,采用SPSS8.0统计软件对临床数据进行单因素及多因素生存分析,以发现影响乳腺癌长期生存的因素。结果：所有患者1、2、3、5和8年生存率分别为95.71%（223/233）、82.83%（193/233）、61.37%（143/233）、37.34%（87/233）和6.87%（16/233）。单因素分析显示腋淋巴结转移数目;原发肿瘤大小与生存呈负相关（P均〈0.001）;TNM晚期患者复发转移的患者中位生存明显缩短（P均〈0.0001）;术后辅助化疗方案选择含有蒽环类的方案组生存期优于不含有蒽环类的方案组（P〈0.05,X^2=9.99）;病理类型治疗方式与生存时间相关（P均〈0.01）。COX比例风险模型分析显示治疗方式、术后辅助性化疗方案和复发转移具有独立预后意义（P〈0.05）。Logistic分析结果显示,原发肿瘤大小、腋窝淋巴结转移状态、病理类型、综合治疗方式是影响乳腺癌复发转移的主要因素,其影响程度的排序依次是腋窝淋巴结转移、原发肿瘤大小、病理类型、综合治疗方式（P〈0.0001）。结论：乳腺癌患者的远期生存及复发转移与原发肿瘤大小、腋窝淋巴结转移状态、病理类型、术后化疗方案的选择及个体化综合治疗方式密切相关。     

影响胃癌预后因素217例临床分析

目的：回顾性分析２１７例胃癌的临床疗效。方法：自１９８０年１月至１９８９年１２月间对２１７例胃癌病人行手术治疗和术后化疗，对资料完整的胃癌术后病人作预后因素的分析。结果：按国际ＴＮＭ分期，５年生存率Ｉ期１００％、Ⅱ期６６．１％、Ⅲａ期５２．６％、Ⅲｂ期２９．５％、Ⅳ期为０。结论：生存率随分期趋晚而逐渐降低，同时，其预后与胃癌的病理类型和术后化疗有关。     

老年进展期胃癌预后的影响因素分析

目的 探讨老年进展期胃癌患者的预后及影响预后的因素。方法 回顾性分析2010年1月至2012年12月174例≥70岁接受化疗的进展期胃癌患者的临床资料,生存分析采用Kaplan-Meier法,多因素分析采用Cox比例风险模型。结果 174例患者一线化疗的有效率（RR）为31.5％（51／162）,疾病控制率（DCR）为73.5％（119／162）,中位生存期（OS）为11.4个月（95％ CI：10.4～12.4月）,1年、2年生存率为39.0％和17.0％。两药方案的RR和中位OS高于单药方案（35.8％ vs.17.9％,P=0.037;14.1个月和7.5个月,P=0.010）,两方案DCR的差异无统计学意义;化疗1～2个周期、3～4个周期、≥5个周期的中位OS分别为7.7个月、13.1个月和21.5个月（P＜0.001）;仅接受一线化疗132例患者的中位OS为10.7个月,接受二线化疗42例患者的中位OS为16.7个月（P=0.006）。Cox多因素分析显示,ECOG评分、转移个数、癌胚抗原、糖类抗原199、乳酸脱氢酶、化疗周期数和进展后是否接受二线化疗是影响预后的独立因素。结论 多周期化疗和一线化疗进展后接受二线化疗可改善老年进展期胃癌患者的预后。     

Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric cancer

Background. This clinicopathological study evaluated the utility of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 as predictors of locoregional recurrence and long-term disease-free survival in patients with gastric cancer. Methods. During the period January 1989 to December 1994, 485 patients with primary gastric cancer were evaluated. Gastrectomies were performed in 434 patients. Prognostic factors were analyzed by the Kaplan-Meier method and multivariate analysis, using Cox regression. Results. Elevated serum CEA and CA19-9 levels were observed in 92 of the 485 patients (19.0%), and in 95 of the 435 patients (21.8%), respectively, and both markers were elevated in 29 of these 435 patients (6.7%). Elevated serum CEA and CA19-9 levels correlated well with lymph node metastasis, lymphatic invasion, vessel invasion, stage grouping, depth of invasion, and curability. Patients with elevated serum CEA levels were at significantly higher risk of having all recurrence factors than were those with normal serum CEA levels. Patients with elevated serum CA19-9 levels were at significantly higher risk of having peritoneal metastases and distant metastases than were those with normal serum CA19-9 levels. A significant difference in the cumulative survival curves of patients was demonstrated between those with elevated and those with normal serum CEA or CA19-9 levels, even for patients at the same disease stage (stage III). Patients with elevated levels of both markers had a significantly worse prognosis than patients in whom the levels of both markers were normal. In patients who underwent gastrectomy, elevated serum CEA levels either preoperatively or within 3 weeks after gastrectomy were associated with significantly worse prognosis than were normal levels. When the cutoff level of serum CEA was increased to 10 ng/ml, serum CEA, age, lymph node metastasis, and surgical stage grouping were selected as independent prognostic factors by multivariate analysis of 14 prognostic factors, using Cox regression. Conclusion. Serum CEA and CA19-9 levels provide additional prognostic information in patients with primary gastric cancer. In particular, an elevated serum CEA level provides additional prognostic information and is a useful indicator of curability in patients who undergo gastrectomy. Serum CEA level is an independent prognostic factor in patients with primary gastric cancer. Received: June 20, 2000 / Accepted: November 14, 2000     

Association of the age-adjusted Charlson Comorbidity Index and systemic inflammation with survival in gastric cancer patients after radical gastrectomy

PurposeTo examine the associations of the Age-Adjusted Charlson Comorbidity Index (ACCI) and preoperative systemic inflammation with survival in gastric cancer (GC) patients who underwent radical gastrectomy.MethodsData from patients with GC who underwent radical gastrectomy between January 2009 and December 2014 in Fujian Medical University Union Hospital were retrospectively analyzed. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors. The relationship between the ACCI and systemic inflammation of the patients was explored, and the prognostic value of a new scoring system based on the ACCI and systemic inflammation (ANLR) was evaluated.ResultsA total of 2257 patients with GC were included. The ACCI and neutrophil to lymphocyte ratio (NLR) were independent prognostic factors for overall survival (both P < 0.001) by multivariate analysis. A higher ACCI was an independent predictor of the increase in preoperative NLR (P < 0.001). Based on the preoperative ACCI and NLR, we established a novel marker, ANLR. Multivariate analysis showed that the ANLR was a significant independent predictor of 5-year OS (P < 0.001). The Harrell's C-statistics (C-index) of a model combining the ANLR and pTNM was 0.744 (95% CI: 0.728–0.760), which was significantly higher than the pTNM stage (0.717, 95% CI: 0.702–0.731; P < 0.001).ConclusionThe ACCI of patients with gastric cancer was associated with preoperative systemic inflammation. The ACCI combined with the NLR, which are commonly collected biomarkers, could enhance prognostication for GC patients.     

Prognostic value of D-dimer levels in patients with gastric cancer undergoing gastrectomy

BackgroundPlasma D-dimer levels have been associated with tumor progression and oncological outcomes in several cancers. This study assessed the relationships of D-dimer levels with clinicopathological features and survival outcomes in patients with gastric cancer undergoing gastrectomy.MethodsData from 666 patients with gastric cancer who underwent gastrectomy between June 2012 and December 2015 were collected and analyzed; these data were acquired during a previous randomized clinical trial (PROTECTOR trial, NCT01448746). Optimal cut-off values of preoperative, immediate postoperative, postoperative-day 1, postoperative-day 4, and postoperative-day 30 D-dimer levels for predicting overall survival (OS) and disease-free survival (DFS) were determined using Contal and O'Quigley's method. The optimal cut-off value of the immediate postoperative D-dimer level for predicting OS was 3.33. Patients were divided into D-dimer high and low groups based on these cut-off values.ResultsHigh immediate postoperative D-dimer levels were significantly associated with advanced T stage and TNM stage (P = 0.001 and P = 0.006, respectively). OS and DFS were significantly lower for patients in the D-dimer high group than for patients in the D-dimer low group; this relationship was consistent for preoperative, immediate postoperative, postoperative-day 1, and postoperative-day 30 D-dimer levels. Multivariate analysis identified the immediate postoperative D-dimer level as an independent prognostic factor for OS (hazard ratio, 2.52; P = 0.010).ConclusionsElevated immediate postoperative D-dimer level was predictive of poor long-term outcomes in patients with gastric cancer after gastrectomy. Immediate postoperative D-dimer levels may offer simple and inexpensive clinical decision-making guidance for patients with gastric cancer after gastrectomy.     

胃癌患者术前血小板／淋巴细胞比值的预后意义

目的 探讨术前外周血血小板／淋巴细胞比值（PLR）对胃癌患者预后的影响。方法选取2008年9月至2009年12月在本院收治的184例胃癌患者作为研究对象,根据PLR是否＜150,将患者分为低PLR组（＜150）125例和高PLR组（≥150）59例,比较两组的临床病理特征和术后1、2、5年生存率及无病生存率,采用Cox风险回归模型评估影响胃癌患者预后的因素。结果 与低PLR组相比,高PLR组的肿瘤浸润深度深、淋巴结转移数多、TNM分期晚、白蛋白低（P＜0.05）。高PLR组和低PLR组1、2、5年生存率分别为74.6％、54.2％、37.3％ 和89.6％、77.6％、57.6％,两组差异有统计学意义（P=0002）。高PLR组和低PLR组1、2、5年无病生存率分别为52.56％、42.4％、23.7％ 和84.8％、72.0％、49.5％,两组差异有统计学意义（P＜0.001）。单因素分析显示,PLR、肿瘤浸润深度、淋巴结转移、TNM分期、年龄及白蛋白与总生存期（OS）和无病生存期（DFS）有关（P＜0.05）。Cox多因素分析显示,TNM分期是影响OS的独立预后因素（HR=6.344,95％CI：4.125～9.757,P＜0001）;TNM分期、PLR和白蛋白是影响DFS的独立预后因素（HR=4.600,95％CI：3.272～6.468,P＜0.001;HR=1.630,95％CI：1.070～2.483,P=0.023;HR=0.470,95％CI：0.259～0.853,P=0.013）。结论 术前PLR是影响胃癌DFS的独立预后因素,OS的预后意义需进一步研究。     

Risk factors for double primary malignancies and their clinical implications in patients with sporadic gastric cancer

Aims

We carried out a large scale study to identify the risk factors for double primary malignancy (DPM) development in gastric cancer patients and to evaluate the clinical implications for these patients.

Methods

A total of 2593 patients who underwent gastrectomy for primary gastric cancer from January 2005 to November 2010 were reviewed with regard to DPM. We compared the clinicopathological characteristics, risk factors for developing DPM, and prognosis between the DPM(+) group and the DPM(−) group.

Results

Of the 2593 patients, 152 (5.9%) were diagnosed with DPM. The most common accompanying malignancies were colorectal, lung and thyroid. Multivariate analysis indicated that age (p = 0.016) and MSI status (p = 0.002) were associated with a higher frequency of DPM. 30.3% of patients were diagnosed with DPM within 1 year around perioperative period and 53.3% of patients had DPM detected during 5 years of post-operative follow up periods. Although there was no significant difference in overall survival between the DPM(+) and DPM(−) group, DPM(+) patients had a worse prognosis than DPM(−) patients in stage I gastric cancer.

Conclusions

Gastric cancer patients over the age of 60 or with a MSI-high status had an increased risk for developing DPM. Further, in stage I gastric cancer, the presence of DPM was associated with a worse prognosis. Therefore, careful pre- and postoperative surveillance is especially important in these patients.     

沉默调节蛋白4在胃癌组织中的表达及其预后价值

目的 探讨沉默调节蛋白4(sirtuin 4,SIRT4)在人胃癌组织中的表达及其与患者临床病理特征及预后的关系.方法 回顾性分析2013年10月一2014年10月于武汉市中心医院接受手术治疗的117例胃癌患者的临床资料.采用免疫组化法检测胃癌组织及其相应癌旁组织中SIRT4蛋白的表达,并分析SIRT4表达水平与患者临...     

预后营养指数与胃癌病理特征的相关性分析

目的 探讨OPNI 及临床病理特征对胃癌患者预后的影响。方法   选取46 例接受胃癌根治术患者,回顾性分析 其临床资料,根据每例患者入院时化验结果计算每位患者的OPNI,计算公式为OPNI= 血清白蛋白水平（g/L）+5× 外周 血淋巴细胞总数（×109/L）。采用受试者工作特征曲线计算Youden 指数,获取具有最佳敏感度和特异度组合的OPNI 作 为本组患者OPNI 分界值,并以此将本组患者分为高OPNI 组及低OPNI 组,采用Kaplan-Meier 生存曲线和Cox 比例风险 模型研究OPNI 对胃癌预后的影响。结果  淋巴结无转移、pTNM 分期为Ⅱ期、CEA 及 CA199 未升高、术后未出现并发症 的胃癌患者OPNI 平均值均明显高于对照组。而采用4 年生存作为终点绘制OPNI 的 ROC 曲线,当OPNI 值为38.175 时, Youden 指数最大,因此以OPNI=38.175 将本组患者分为高OPNI 组和低OPNI 组,与低OPNI 组的患者相比,高OPNI 组 的患者肿瘤浸润深度更浅、淋巴结转移更少、pTNM 分期相对早期、CEA 及 CA199 水平均处于正常范围内。单因素及多 因素分析显示,患者年龄和OPNI 值是胃癌患者总生存时间的独立预后因素。结论  OPNI 可作为一项简洁直观的指标来协 助临床医生判断胃癌患者的预后。