56例青年人胃癌临床病理及其生存分析

【摘要】 目的 探讨青年人胃癌的临床病理特点及预后。方法 回顾性分析2005年1月至2010年12月初治的56例青年人胃癌（年龄≤40岁）的临床资料,并随机选取同期56例老年人胃癌（年龄≥60岁）作对照。采用SPSS13.0统计软件分析青年人胃癌的临床病理特点及与预后的关系。结果 56例青年人胃癌女性比例高于男性（χ2 =11.593,P=0.001）;肿瘤多位于胃窦部;病理类型以低分化腺癌和未分化癌为主,高于对照组（χ2 =16.586,P＜0.001）;临床分期以中晚期多见;术后生存中位时间为39.56个月,1、3、5 年生存率分别为80.0%、52.0%、24.0%;行根治性手术患者生存率高于姑息性手术患者（χ2 =5.836,P=0.016）;手术方式、肿瘤大小、病理类型、临床分期是影响青年人胃癌预后的主要因素(P＜0.05)。结论 青年人胃癌以女性居多,起病隐匿,确诊多为中晚期,恶性程度高,应重视青年人胃癌的早期诊断,尽早行根治性手术,有助于改善患者预后。     

年龄对胃癌手术短期临床结局影响的回顾性分析

目的探讨年龄对胃癌手术患者短期临床结局的影响。 方法回顾性分析2008年5月到2012年9月收治的432例胃癌患者的临床病理资料,根据年龄将所有纳入患者分为老年组（≥60岁）230例和对照组（<60岁）202例,应用χ²检验、独立样本t检验及非参数检验对各分组患者的临床资料进行比较,用多因素Logistic回归分析各危险因素与术后30 d内发生并发症的关系。 结果两组术前合并症数量、ASA评分、第一次排气时间明显不同,差异有统计学意义（P<0.05）。老年组术后肺部感染率为3.91%（9/230）高于对照组的0.99%（2/202）,差异接近有统计学意义（χ²=3.703,P=0.054）。老年组术后并发症的发生率为24.78%（57/230）,略高于对照组的22.28%（45/202）,差异无统计学意义（χ²=0.374,P=0.541）。而老年患者术后需要ICU监护的比例为14.78%（34/230）,显著高于对照组的1.98%（4/202）（χ²=21.972,P<0.01）。 结论年龄不是影响患者术后并发症的独立危险因素。通过术前风险评估,术中安全监护,对于老年胃癌患者行肿瘤根治术是安全可行的。     

46例青年胃癌诊疗分析

目的探讨青年胃癌的病理及预后特点,提高青年胃癌病人的诊疗水平。方法回顾性分析近10年来在南通大学附属江阴医院行胃癌根治术(D2)的46例青年胃癌病人的临床资料、病理资料及预后情况,用χ2检验比较病人的临床病理特征,用Kaplan-Meier生存分析统计生存率及中位生存时间,用Cox回归多因素分析预后因素。结果不同性别的青年胃癌在肿瘤部位、分型、TNM分期、生存率等方面差异均无统计学意义,Cox回归分析提示组织学类型、TNM分期、肿瘤大小、浸润深度及淋巴结转移与病人预后相关,淋巴结大小、肿瘤部位及性别与预后无关。结论青年胃癌好发于胃窦胃角等远端,以Borrmann III型为主,女性在青年胃癌中比例较高,青年胃癌低分化腺癌比例较高,总体生存率不高。     

肝门部胆管癌的临床诊断与手术治疗分析

目的探讨肝门部胆管癌的临床诊断方法及两种不同手术方法的预后。方法选取2002年12月至2008年3月就诊的肝门部胆管癌患者43例作为研究对象,回顾性分析所有患者的临床表现、影像学检查结果、手术方式、生存率等临床资料,所有对象按手术方法分为根治性切除术组（22例）和姑息性切除术组（21例）,对比分析两组间患者的术后并发症发生率,1、3、5年生存率有无统计学差异。结果临床表现以黄疸最为常见,占86．0％,其次是尿黄（81．4％）和皮肤瘙痒（72．1％）;经过常规超声、CT及MRI联合检查,根治性切除术组和姑息性切除术组对肝门部胆管癌检出率分别为90．9％和95．2％;MRI诊断阳性率明显高于超声诊断阳性率（χ^2=7．379,P〈0．01）。根治性切除术组患者并发症发生率明显高于姑息性切除术组（χ^2=14．321,P〈0．01）,1、3、5年生存率也明显高于姑息性切除术组（r=6．018、χ^2=2．842、r=17．483,P〈0．05）。结论对于肝门部胆管癌患者,MRI诊断阳性率明显高于超声,采取超声联合CT或MRI可提高早期诊断率;根治性切除术治疗肝门部胆管癌,能够提高此类患者的远期存活率。     

新辅助化疗联合胃癌根治术治疗老年进展期胃癌患者的疗效分析

目的探讨新辅助化疗联合胃癌根治术治疗老年进展期胃癌患者的安全性和有效性。方法回顾性分析2012年1月至2020年10月于华中科技大学同济医学院附属协和医院接受新辅助化疗的148例进展期胃癌患者的临床资料, 分为中青年组(111例)和老年组(37例), 比较其临床病理和预后。结果两组在新辅助化疗所致的贫血(χ2=0.235, P=0.628)、白细胞减少(χ2=0.613, P=0.434)、中性粒细胞减少(χ2=0.011, P=0.918)及血小板减少(χ2=0.253, P=0.615)等血液学并发症和恶心(χ2=0.092, P=0.762)、呕吐(χ2=0.166, P=0.683)、腹泻(χ2=0.015, P=0.902)及黏膜炎(χ2=0.199, P=0.766)等非血液学并发症发生率方面差异均无统计学意义。老年组与中青年组在手术时间(t=0.270, P=0.604)、术中出血量(t=1.140, P=0.250)和R0切除率(χ2=0.105, P=0.750)方面差异均无统计学意义。中青年组与老年组术后并发症发生率分别为25.2%、37.8%, 差异无统计学意义(...     

1979—2008年山东聊城一间医院胃癌手术患者临床病理特征的变化

目的 探讨一间医院30年来胃癌手术患者临床病理特征的变化趋势.方法 分析山东省聊城市人民医院1979-2008年间收治的2715例胃癌手术患者（研究组）的临床资料,并与1974-1978年间收治的168例患者（对照组）临床资料进行比较.结果 研究组患者男女性别比为3.393,高于对照组的 1.897（χ2 ＝12.193,P＜0.01）.研究组患者的中位年龄为59岁,高于对照组的54岁（z＝-6.294,P＜0.01）.研究组与对照组肿瘤部位比较：胃底贲门癌构成比为45.7%比13.0%（χ2＝56.596,P＜0.01）,胃体癌构成比为9.4%比13.8%（χ2＝2.026,P＝0.155）、胃窦癌构成比为44.9%比73.2%（χ2＝ 53.980,P＜0.01）.研究组中,2004-2008年间组低分化腺癌构成比为62.1%,较1994-1998年间组的51.7%升高（χ2＝12.267,P＜0.01）,而管状腺癌构成比降低（23.9%比31.8%,χ2＝8.781,P＜0.01）.时间序列分析表明,年龄亦呈升高趋势（均方根误差＝1.275,可决系数＝0.702）;胃底贲门癌构成比呈升高趋势（均方根误差＝0.066,可决系数＝0.768）,胃窦癌构成比呈下降趋势（均方根误差＝0.055,可决系数＝0.798）.结论 近30年来,胃癌手术患者男女性别比升高、年龄增大;胃底贲门癌构成比升高,而胃窦癌构成比下降;近15年来,低分化腺癌构成比升高,而管状腺癌构成比下降.     

青年与老年直肠癌临床对比分析

目的探讨青年与老年直肠癌的临床、病理及预后差异。方法中国医学科学院肿瘤医院自1990年1月至2000年1月收治40岁以下直肠癌患者138例（青年组），65岁以上者163例（老年组），对这组患者的病例资料进行生存分析和预后的多因素分析。结果青年组Ⅲ期直肠癌患者比例（53．6％，74／138）明显高于老年组（34.3％，55／163）；P=0．001；青年组中黏液腺癌和低分化腺癌患者比例（28．2％，39／138）也高于老年组（10．4％，17／163）P〈0．001。青年组和老年组5年生存率分别为50．4％和64．1％．两组比较差异有统计学意义（P〈0．05）；而按照TNM分期进一步分析显示．同期别两组的生存率差异均无统计学意义（P〉0．05）。多因素分析结果显示，肿瘤T分期（P=-0．001）和淋巴结转移（P〈0．05）是影响两组患者预后的独立因素。结论与老年直肠癌相比，青年直肠癌患者的病期较晚、肿瘤分化程度较低，影响其预后；但相同病期者生存率相似。早期诊疗是提高直肠癌总体生存率的关键。     

老年人胃癌临床病理分析

目的探讨老年人胃癌的临床及病理特点,旨在为其合理诊治提供依据。方法将经手术治疗的324例胃癌病人（≥60岁）人选老年组,81例青年（〈44岁）胃癌病人作为对照。对比分析两组在临床特点及组织、病理学方面的差异。结果两组在临床症状、肿瘤部位、浸润深度、病理分期方面差异无统计学意义（P〉0．05）;在性别构成、病史长短、术前合并症、术后并发症、手术类型、住院时间等方面差异有统计学意义（P〈0．05）。根治性手术后,老年组与青年组3年生存率差异无统计学意义（P〉0．05）。结论老年胃癌病人在临床及病理学方面并未显示出比青年病人更差的结果。老年人胃癌预后的改善仍依赖于早期诊治水平的提高。     

青年胃癌的临床病理特征及其预后分析

目的探讨青年胃癌的临床病理及预后特征,以提高青年胃癌的治疗水平。方法回顾性分析福建医科大学附属协和医院胃外科2004年1月至2006年12月间收治的63例青年胃癌患者（青年组．小于或等于40岁）的临床病理资料及预后情况,并与同期654例中老年胃癌患者（中老年组．大于40岁）进行比较。结果青年组中女性、存在家族史及未分化型患者比例显著高于中老年组（均P〈0．05）。青年组患者根治性切除率61．9％（39／63）,低于中老年组的93．1％（595／654）,差异有统计学意义（P〈0．01）。653例（91．1％）患者获得了1～84个月的随访,青年组和中老年组术后5年生存率分别为40．5％和55．6％．差异有统计学意义（P〈0．05）。多因素预后分析显示,浸润深度、淋巴结转移和手术根治性是影响青年胃癌患者预后的独立因素（均P〈0．05）。分层预后分析显示,行根治性手术的青年组和中老年组患者术后5年生存率分别为63．2％和56．7％．差异无统计学意义（P〉0．05）：行姑息性手术后两组患者5年生存率分别为4．2％和22．2％,差异有统计学意义（P〈0．05）。结论青年胃癌恶性度高．根治性切除率低,总体预后不佳;但积极行根治性手术者可达到与中老年胃癌相似的远期疗效。     

胃黏膜皱襞粗大的胃镜表现特点及病理诊断分析

目的探讨胃黏膜皱襞粗大的胃镜表现特点及病理诊断。方法回顾性分析2002年1月～2008年4月行胃镜检查发现的161例胃黏膜皱襞粗大的临床资料。常规胃镜下活检未能明确诊断可行内镜下黏膜切除术活检或超声胃镜下深凿活检。结果161例中慢性炎症79例（49.1%）,胃癌67例（41.6%）,恶性淋巴瘤11例（6.8%）,Menetrier病2例（1.2%）,急性炎症1例（0.6%）,未见明显病变1例（0.6%）;幽门螺杆菌阳性率42.2%（68/161）,其中胃癌幽门螺杆菌阳性率为34.3%（23/67）。行内镜下黏膜切除术活检15例（9.3%）：慢性炎症5例,胃癌5例,恶性淋巴瘤4例,Menetrier病1例。在胃黏膜皱襞粗大的病变部位分布上,全胃均有病变10例,胃底病变10例,胃体病变86例,胃窦病变5例,胃底和胃体均有病变31例,胃体和胃窦均有病变19例;其中10例全胃均有病变的病理诊断均为胃癌。胃癌与慢性炎症胃镜下均可表现为扩张性差（χ^2=10.093,P=0.001）、蠕动差（χ^2=19.116,P=0.000）、胃腔变窄（χ^2=18.159,P=0.000）、质地硬（χ^2=54.302,P=0.000）、质地脆（χ^2=6.132,P=0.013）、糜烂（χ^2=5.619,P=0.018）和溃疡（χ^2=22.743,P=0.000）,但两者以上表现的差异有统计学意义。结论胃镜下发现的胃黏膜皱襞粗大,诊断上以慢性炎症、胃癌和恶性淋巴瘤为主,偶见Menetrier病和急性炎症。病变部位以胃体居多,当全胃受累时多诊断为胃癌。诊断为恶性病变（胃癌和恶性淋巴瘤）的胃黏膜皱襞粗大胃镜下多合并溃疡,扩张性和蠕动性差。内镜下黏膜切除术活检是一种有效的方法,有助于进一步明确疾病的诊断。     

Prognostic Significance of the Cytologic Features of Free Cancer Cells in the Peritoneal Cavity of Patients with Gastric Cancer

The aim of this study was to determine whether the cytologic features of cancer cells in the peritoneal lavage fluid from patients undergoing surgery for gastric cancer affect prognosis. A total of 141 patients with stage III–IV gastric cancer were enrolled in this study. Among 111 patients without peritoneal metastasis (P0), 43 were noted to have positive peritoneal cytology (P0/CY1). These patients were subclassified into two groups according to the cluster formation of cancer cells in the cytology specimen, namely, 17 with cluster formation and 26 without cluster formation. The clinicopathologic parameters and survival rates were compared between these two groups. Among the P0/CY1 patients, no significant difference in clinicopathologic features existed between patients with or without the cluster formation of cancer cells. However, the survival rate of patients without cluster formation was significantly higher than that of those with cluster formation. Furthermore, the survival curves of patients without cluster formation was similar to that of the P0/CY0 patients with stage IV cancer. Subclassification according to the presence or absence of the cluster formation of cancer cells may be useful for predicting the outcome of patients with positive cytology after surgery for advanced gastric cancer. Received: March 9, 2001 / Accepted: July 17, 2001     

Clinicopathologic association of cyclooxygenase 1 and cyclooxygenase 2 expression in gastric adenocarcinoma

OBJECTIVE: To evaluate the association of clinicopathologic factors and prognostic value with the expression of cyclooxygenase 1 and 2 in patients with gastric adenocarcinoma. SUMMARY BACKGROUND DATA: Epidemiologic studies have indicated that nonsteroidal antiinflammatory drugs reduce the risk of colon cancer by as much as 40% and also decrease the risk of gastric cancer. Recently, gastric cancer was found to express constitutive cyclooxygenase 1 and inducible cyclooxygenase 2 isoenzymes. Nonsteroidal antiinflammatories, which may function as cyclooxygenase inhibitors, inhibited the growth of gastric cancer cells. These two isoenzymes' expressions associated with traditional clinicopathologic factors have not been fully evaluated, and their prognostic value for determining survival in patients remains to be clarified. METHODS: Seventy-one specimens resected from patients with gastric adenocarcinoma were investigated by immunohistochemical stain against cyclooxygenase 1 and 2. The 71 specimens were divided into stain-positive and stain-negative groups. Correlations between cyclooxygenase 1 and 2 expression, various clinicopathologic factors (including vascular invasion and Helicobacter pylori infection), and prognosis were studied. RESULTS: The cyclooxygenase 2-positive group was significantly correlated with vascular invasion and H. pylori infection by univariate and multivariate analysis. In patients with cyclooxygenase 2-positive cancer, the prognosis was significantly poorer than in those with cyclooxygenase 2-negative cancer. However, multivariate analysis showed that vascular invasion, serosal invasion, and lymph node metastasis were independent prognostic factors for patients with gastric cancer, but cyclooxygenase 2 expression was not. There was no significant correlation between cyclooxygenase 1 expression and clinicopathologic factors and prognosis. CONCLUSIONS: Upregulated cyclooxygenase 2 expression was associated with H. pylori infection in gastric cancer and was also strongly correlated with positive vascular invasion, which was an independent prognostic factor for poorer survival in this study. The usefulness of cyclooxygenase 2 inhibitors in the prevention or treatment of gastric cancer remains undetermined but deserves further investigation.     

胃癌腹膜扩散的临床病理特征及预后分析

目的 探讨胃癌腹膜扩散患者的临床病理因素以及姑息性切除术对其预后的影响。方法 回顾性分析1994年8月至2005年7月间胃癌数据库资料中患者的临床病理资料及随访结果。结果 792例原发性胃癌患者中发生腹膜扩散105例（13．3％）。肿瘤穿透浆膜、淋巴结转移、全胃癌、未分化癌、BorrmannⅣ型、女性患者与腹膜扩散相关（P〈0．05）。腹膜扩散患者1、3、5年生存率分别为57％、23％、22％。接受姑息性切除术患者术后1、3、5年生存率分别为66％、25％和20％，姑息性切除术后1年内各时点生存率均高于接受旁路手术或喂食性造口术患者和仅行剖腹探查患者（P〈0．05），而3组间术后3、5年生存率比较差异无统计学意义。结论 胃癌腹膜扩散患者具有较差的临床病理特征；姑息性切除术可改善胃癌腹膜扩散患者的近期预后。     

The outcome of patients with remnant primary gastric cancer compared with those having upper one-third gastric cancer

BACKGROUND: Although the prognosis for patients with remnant gastric cancer has been considered to be poor, few reports exist concerning outcomes of these patients. The objective of this study was to evaluate clinicopathologic features and prognostic outcomes of patients with remnant primary gastric cancer compared with the same findings for patients with upper-one third cancer of the stomach. METHODS: Thirty-eight patients with remnant primary gastric cancer and 794 patients with primary upper one-third cancer who underwent surgery at Samsung Medical Center between 1995 and 2004 were enrolled in this study. Clinicopathologic characteristics, tumor stages, and survival times were analyzed. RESULTS: The mean interval between previous gastrectomy and diagnosis of remnant primary gastric cancer was 18.8 years for patients who had undergone their first gastrectomy for malignant disease (n = 13) and 28.6 years for patients with benign disease (n = 25). Patients with remnant primary gastric cancer showed a greater male predominance compared with patients having upper one-third cancer (92.1% vs 65.5%, respectively, P = .001). Patient distribution according to operative curability, tumor size, stage, and histology showed no significant differences between the 2 groups. Overall 5-year survival rates of patients with remnant primary gastric cancer and those with upper one-third cancer were 53.7% and 62.9% (P = .346), respectively. Differences in the 5-year survival rates at each stage between the groups were not statistically significant. CONCLUSIONS: Operative curability, tumor stages, and prognoses of patients with remnant primary gastric cancer are similar to those having upper one-third cancer. Early diagnosis and an aggressive surgical approach may be important to achieve better outcomes for patients with remnant primary gastric cancer.     

Surgical Outcomes for Gastric Cancer in the Upper Third of the Stomach

Introduction The proportion of gastric cancers affecting the upper third of the stomach has been increasing. At our surgical service we perform total and proximal gastrectomy for this condition. The purpose of this study was to investigate the surgical outcome of the two operative procedures and determine an optimal surgical approach. Methods Data from 147 patients who underwent resection for gastric cancer affecting the proximal one-third of the stomach were retrospectively analyzed. The patients were classified into a total gastrectomy (TG) group or a proximal gastrectomy (PG) group, and the clinicopathologic characteristics and surgical results were compared. We analyzed survival rates using Kaplan-Meier methods and made comparisons using a log-rank test across the same stage of the gastric cancer. Results From 1992 to 2000, a total of 104 total gastrectomies and 43 proximal gastrectomies for gastric cancer affecting the upper one-third of the stomach were performed. Our investigation revealed significantly different clinicopathologic characteristics in Borrmann type, length of the resection margin, degree of lymph node dissection, and lymph node stage. During the procedure, a combined resection of other organs was performed in 30 TG and 27 PG patients. Postoperative complications developed in 15 TG and 22 PG patients. The cancer recurrence rate was 4.8% for the TG group and 39.5% for the PG group; it was highest when the length of the proximal resection margin was < 1 cm. When we compared 5-year survival rates between the two groups, each at the same cancer stage, a significant difference was noted for stage III and IV gastric cancers. Conclusions Proximal gastrectomy may be performed during the early stage of proximal gastric cancer; but because of the high frequency of complications and cancer recurrence, an additional procedure should be expected afterward. When the cancer stage is advanced, total gastrectomy should be performed with sufficient length of the proximal resection margin.     

Role of glucocorticoid receptor in serosa-involved gastric carcinoma after gastrectomy

Glucocorticoid receptor (GR) was first found in the cytosol of gastric cancer tissue more than 15 years ago. At present, most gastric cancers are diagnosed at the advanced stage. To elucidate the role of GR in gastric cancer, the GR levels of the cancer tissue of 75 consecutive patients with grossly serosa-involved gastric carcinoma were determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term survival duration were compared in patients with GR-positive and GR-negative cancer cells. We found that GR could be detected in the cytosol of cancer cells in 31 (41.3%) of the gastric cancer patients with a median concentration of 18.5 (range, 1.03–73.9) fmol/mg protein. No significant differences could be found in any clinicopathologic characteristic between the patients with GR-positive and GR-negative cancers. After multivariate analysis, gross Borrmann’s type, metastatic lymph node number, and GR positivity were the independent prognostic factors after gastrectomy for serosa-involved gastric carcinoma. GR-positive gastric cancer had a worse survival rate than GR-negative gastric cancer. Multimodality adjuvant therapies should be considered in patients with GR-positive serosa-involved gastric carcinoma. Supported by Taichung Veterans General Hospital, grant numbers TCVGH 914607C and 924603C (to C.-C.W.).     

Prognostic significance of carcinoembryonic antigen levels in peritoneal washes in patients with gastric cancer.

BACKGROUND: Peritoneal metastasis is the most frequent cause of death in patients with gastric cancer. Detection of free cancer cells in the peritoneal cavity at the time of surgery, therefore, is considered to be of great value in predicting the peritoneal recurrence and accordingly in the prognosis in patients with gastric cancer. This study examined the clinical significance of intraoperative determination of carcinoembryonic antigen (CEA) levels in peritoneal washes (pCEA) in patients with gastric cancer. METHODS: CEA levels in peritoneal washes were correlated retrospectively with several clinicopathologic factors including clinical outcome in 56 patients with resectable gastric cancer. RESULTS: Among several clinicopathologic factors, the depth of tumor invasion significantly and independently correlated with pCEA levels as revealed by multivariate stepwise logistic regression analysis. A significant difference in overall survival rates was observed between pCEA-positive and pCEA-negative groups: 5-year survival rates were 95.7% in pCEA-negative and 20% in pCEA-positive patients (P <0.0001). Multivariate analysis indicated that pCEA level is a statistically significant independent prognostic factor for the survival of patients with gastric cancer, and is an important factor for predicting peritoneal recurrence. CONCLUSIONS: pCEA could be a potential predictor of a poor prognosis as well as peritoneal recurrence in patients with gastric cancer. We believe that this information could contribute to determining the optimal intraoperative and postoperative therapeutic plan including adjuvant chemotherapy of gastric cancer.     

Impact of screening survey of gastric cancer on clinicopathological features and survival: retrospective study at a single institution

BACKGROUND: Detection of gastric cancer in an early stage is important to improve the prognosis of patients with gastric cancer. This study compared the clinicopathologic characteristics and surgical results in patients with asymptomatic gastric cancer detected by a screening program with those of patients with symptomatic cancer. The efficacy of 2 screening methods (barium meal and endoscopy) was also compared. METHODS: The subjects included 196 patients with asymptomatic gastric cancer detected by screening (screening group) and 612 patients with symptomatic gastric cancer (nonscreening group) treated from 1979 to 1997. The screening group was subdivided into the barium meal study group (n = 150) and the endoscopic study group (n = 46). RESULTS: The incidences of early gastric cancer and 5-year survival rates between the screening and nonscreening groups were 77% versus 29% (P <.0001) and 81% versus 44% (P <.0001), respectively. The endoscopic study appeared to be able to detect smaller gastric cancer in an earlier stage compared with the barium meal study, although no statistical differences in survival rate were noted between these 2 screening methods. CONCLUSIONS: Screening plays an important role in detecting gastric cancer in an early stage and in potentially reducing death attributable to gastric cancer. Endoscopic screening is recommended as the best screening method.     

神经旁浸润阳性胃癌患者的临床特征与预后分析

背景与目的 神经旁浸润（PNI）是胃癌局部外侵转移的生物学特性之一,其临床价值尚未得到重视。本研究旨在探讨胃癌伴发PNI的临床病理特征以及PNI对胃癌患者预后的影响。方法 回顾性分析2011年6月—2016年12月期间施行开腹根治性胃切除手术的543例胃癌患者的临床病理资料。根据癌组织PNI结果,胃癌患者分为PNI阳性组和PNI阴性组,比较两组在临床病理指标上的差异。应用倾向评分匹配法均衡两组与预后相关的基本资料变量,采用Kaplan-Meier法进行生存分析,采用Cox风险回归模型分析与PNI阳性胃癌患者术后生存相关的危险因素。结果 全组胃癌患者中PNI阳性率21.18%（115/543）。匹配前两组的肿瘤大小、肿瘤部位、细胞分化程度、肿瘤TNM分期、脉管侵犯、手术切除范围及术后辅助化疗等方面差异有统计学意义（均P<0.05）;匹配后,PNI阳性组56例,PNI阴性组98例,两组患者基线资料均衡（均P>0.05）。PNI阳性组的总生存时间（OS）明显短于PNI阴性组（中位OS：19个月vs. 49个月,P=0.002）;亚组分析显示,TNM I~II患者中,PNI阳性对OS无明显影响（P=0.432）,但明显缩短III期患者的OS（中位OS：18个月vs. 2个月,P<0.001）。在PNI阳性患者中,术后辅助化疗对I~II期患者的OS无明显影响（P=0.975）,但能明显延长III患者的OS（中位OS：18个月vs. 2个月,P<0.001）。单因素分析结果提示年龄（P=0.008）、TNM分期（P=0.034）和术后辅助化疗（P=0.006）与PNI阳性胃癌患者术后预后紧密相关;多因素分析发现TNM分期处于III期（HR=2.591,95% CI=1.291~5.198,P=0.007）、未进行术后辅助化疗（HR=0.345,95% CI=0.184~0.649,P=0.001）是影响PNI阳性胃癌患者预后的独立危险因素。结论 PNI阳性胃癌患者的预后明显差于PNI阴性胃癌患者,其对预后的影响在TNM III期患者中尤为明显。积极的术后辅助化疗有助于改善该类胃癌患者的预后。     

早期胃癌临床病理特征与预后因素的分析

目的：探讨早期胃癌临床病理特征与预后的关系。方法：采用单因素与多因素的分析方法，回顾性分析1994年至2000年间在我院接受手术且有完整临床资料和随访结果的137例早期胃癌病人的临床病理特征及其对预后的影响。结果：单因素分析显示肿瘤大小、浸润深度及淋巴结转移与早期胃癌的预后相关。多因素分析提示淋巴结转移是早期胃癌预后的独立危险因素。在本组无淋巴结转移的早期胃癌病人中，其术后5年生存率为93．2％，显著优于淋巴结转移者；其中有1～3枚淋巴结转移者，术后5年生存率为88．9％；有4枚及以上淋巴结转移者．术后5年生存率仅为30％，（P〈0．05）。血行转移是早期胃癌病人术后复发的主要类型。结论：淋巴结转移是影响早期胃癌预后的重要指标，术前评估早期胃癌的淋巴结转移状态有助于选择合理的治疗方案。应重视早期胃癌病人的术后随访。