71例胃癌根治术后复发类型及相关因素分析

目的:探讨胃癌复发的类型和危险因素及胃癌根治术后生存相关因素,为预防胃癌根治术后复发提供依据。方法:回顾性分析71例胃癌复发病例的复发类型、复发时间和原发胃癌的临床病理特征,并与同期治疗的94例无复发胃癌病例作对照。用单因素和多因素分析胃癌患者术后复发及复发时间的相关因素。结果:胃癌复发主要为腹腔内复发,共64例(90.1%)。单因素字2检验分析结果显示,复发组与无复发组在肿瘤大小、Borrmann分型、分化程度、浸润深度、有无浆膜浸润、阳性淋巴结个数、淋巴结清扫范围、TNM分期及术后有无6～8周期化疗等方面差异具有统计学意义(P<0.05)。多因素Logistic回归分析表明,有无浆膜浸润、阳性淋巴结个数、手术清扫淋巴结范围、TNM分期及术后有无6～8周期化疗是胃癌复发的相关因素(P<0.05)。复发者2年内复发57例,占复发总数的80.3%;COX回归分析显示,阳性淋巴结个数、TNM分期和术后有无6～8周期化疗是影响胃癌患者术后2年内复发的主要因素(P<0.05)。结论:术前相对准确的TNM分期以及标准的胃癌根治术和术后规范化疗,加强术后2年内的随访程度,是提高胃癌术后生存率的关键。

Analysis on the patterns and relevant factors of recrudescent gastric cancer in 71 patients who underwent radical resection

Objective: To explore the patterns and relevant factors of recrudescent gastric cancer in patients who underwent radical resection.Methods: Seventy-one patients with recurrent gastric cancer after curative gastrectomy were enrolled in this study.The patterns of recurrent tumor and clinicopathologic characters of primary tumors were analyzed retrospectively and compared with 94 cases without recurrence,who were treated homeochronously.Factors correlated with tumor recurrence and recurrence time were studied by univariate and multivariate analysis.Results: The recurrence of gastric cancer was mainly in the abdominal cavity,for 64 cases(90.14%).Univariate χ2 analysis showed that there was statistic difference in tumor size,Borrmann types,differentiation degree,invasive depth,serosa infiltration,the number of positive lymph nodes,lymph node dissection range,TNM staging and completed 6～8 cycles of chemotherapy between recurrence group and none recurrence group(P<0.05).Multivariate Logistic analysis showed that the serosa infiltration,the number of positive lymph nodes,lymph node dissection range,TNM staging and completed 6～8 cycles of chemotherapy were independently correlated with tumor recurrence after curative gastrectomy(P<0.05).In 71 recurrence patients,57 patients recurred cancer in 2 years(80.28%).COX regression analysis showed the number of positive lymph nodes,TNM staging and completed 6～8 cycles of chemotherapy were dominating parameters in early tumor recurrence(P<0.05).Conclusion: Relatively accurate preoperative TNM grading,standard radical resection and post-operative chemotherapy of gastric cancer along with enhancing the degree of follow-up in 2 years after operation may play important roles in improving post-operative long-term survival.