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目的探讨肿瘤大小对早期胃癌预后的影响。方法自1995年4月至2006年6月,福建医科大学附属协和医院胃外科对159例早期胃癌病人施行根治术。应用ROC曲线选取肿瘤大小的最佳截点。对病人预后因素进行单因素及多因素分析,对影响病人预后的独立因素进行分层分析。结果通过ROC曲线筛选出早期胃癌肿瘤直径最佳截点为23mm,其中肿瘤直径<23mm病人84例(小直径组),肿瘤直径≥23mm者75例(大直径组)。小直径和大直径组的术后5年存活率分别为98.8%和80.6%,差异具有统计学意义(P<0.01)。通过COX比例风险模型分析显示,肿瘤大小、浸润深度、淋巴结转移是影响全组病人预后的独立危险因素(P<0.05)。进一步分层分析发现,无淋巴结转移或浸润黏膜下层的早期胃癌病人,大直径组的5年存活率低于小直径组(P<0.01)。结论肿瘤直径大小的截点为23mm时,可显著影响无淋巴结转移或浸润黏膜下层的早期胃癌病人的预后。

Prognostic impact of tumor size in early gastric cancer

??Prognostic impact of tumor size in early gastric cancer LU Jun, HUANG Chang-ming, ZHENG Chao-Hui, et al. Department of Stomach, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Corresponding author: HUANG Chang-ming, E-mail: hcmlr2002@163.com
Abstract Objective To investigate the impact of tumor size in the prognosis of early gastric cancer. Methods In Fujian Medical University Union Hospital,a total of 159 patients with early gastric cancer(EGC), underwent curative gastrectomy during April,1995 to July,2006 were retrospectively analyzed.The best cut-off point depending on tumor size was selected by ROC curve. Both univariate and multivariate analysis were used to analyze the prognosis of this group. The independent prognostic factors of patients were performed subgroup analysis. Results Receiver operating characteristics (ROC) analysis showed that the most sounded cut-off point for tumor size was 23 small-size tumors (SST, ??23 mm) and large-size tumors (LST, ≥23 mm). The 5-year survival rates were 98.8% and 80.6% of SST and LST patients respectively,and the differences was statistically significant (P<0.01). COX proportional hazards regression model indicated that the tumor size , submucosal invasion,lymph node metastasis were independent prognostic factors affecting the whole group??P<0.05??. Further stratified analysis indicated, that the 5-year survival rate of LST was significantly lower than that of SST in EGC patients without lymph node metastasis or submucosal invasion (P<0.01).Conclusions Tumor size cut-off point of 23 mm can exert significant impact on the prognosis of EGC patients without lymph node metastasis or submucosal invasion.