癌结节对胃癌患者预后的影响

目的探索癌结节与胃癌临床病理特征之间的关系,分析其对胃癌患者预后的影响。方法2012年1月1日至2015年1月1日在河北医科大学第四医院外三科行根治性手术治疗的胃癌患者2386例,分析癌结节与临床病理特征的关系及其对胃癌患者总生存和无病生存的影响。结果2386例胃癌患者中,459例(19.24%)有癌结节,1927例无癌结节。Logistic多因素分析结果显示,pT分期(P=0.036)、pN分期(P=0.024)、pTNM分期(P=0.032)、Borrmann分型(P=0.008)、有无脉管瘤栓(P=0.001)是形成癌结节的独立危险因素。共有2273例患者获得随访,随访期内1259例患者发生复发转移,1152例死亡,5年总生存率和5年无病生存率分别为49.32%和44.61%。有癌结节组患者(441例)的5年总生存率和5年无病生存率分别为26.76%和24.94%,无癌结节组患者(1832例)的5年总生存率和5年无病生存率分别为54.75%和49.34%,两组差异均有统计学意义(均P<0.001)。1个癌结节组(115例)、2~3个癌结节组(202例)和≥4个癌结节组(124例)患者的5年总生存率分别为41.74%、30.69%和10.48%,差异有统计学意义(P<0.001);5年无病生存率分别为40.00%、28.22%和9.68%,差异也有统计学意义(P<0.001)。Cox多因素分析显示,组织学类型(P=0.004)、pT分期(P=0.007)、pN分期(P=0.004)、pTNM分期(P=0.002)、有无脉管瘤栓(P=0.034)、有无癌结节(P=0.005)和癌结节数量(P=0.001)是胃癌患者预后的独立危险因素,术后辅助化疗(P=0.043)是胃癌患者预后的保护性因素。结论癌结节的发生与多种临床病理因素密切相关,有无癌结节及癌结节数量是影响胃癌患者预后的独立危险因素。

The effect of cancer nodules on survival prognosis of gastric cancer patients

Objective To explore the relationship between cancer nodules and clinicopathological characteristics of gastric cancer,and analyze its impact on survival prognosis of gastric cancer patients.Methods A retrospective analysis of 2386 patients with gastric cancer who underwent radical surgery from January 1,2012 to January 1,2015 in the Third Surgery Department of the Fourth Hospital of Hebei Medical University was performed.The relationship between cancer nodules and clinicopathological characteristics of gastric cancer and its impact on survival prognosis of gastric cancer patients were analyzed.Results Among the 2386 patients,there were 459 cases(19.24%)with cancer nodules,and 1927 cases(80.76%)without cancer nodules.Logistic multivariate analysis showed that pT staging(P=0.036),pN staging(P=0.024),pTNM staging(P=0.032),Borrmann classification(P=0.008),vascular tumor thrombus(P=0.001)were independent risk factors for cancer nodules.The complete follow-up date of 2273 cases(95.26%)of 2386 patients with gastric cancer were obtained.A total of 1259 patients relapsed and 1152 died during the follow-up period.The 5-years overall survival(OS)rate was 49.32%,and the 5-years disease-free survival(DFS)rate was 44.61%.Among them,the 5-years OS rate and DFS rate of those with cancer nodules were 26.76%and 24.94%,while the 5-years OS rate and DFS rate of those without cancer nodules were 54.75%and 49.34%,respectively(P<0.001).Patients with positive cancer nodules were divided into 3 groups according to the number of cancer nodules:1(115 cases),2 to 3(202 cases),and more than 4(124 cases).The 5-years OS rates of 3 groups were 41.74%,30.69%and 10.48%,respectively(P<0.001).The 5-years DFS rates were 40.00%,28.22%and 9.68%,respectively(P<0.001).Cox multivariate analysis showed that histological type(P=0.004),pT staging(P=0.007),pN staging(P=0.004),pTNM staging(P=0.002),vascular tumor thrombus(P=0.034),cancer nodules(P=0.005)and the number of cancer nodules(P=0.001)were independent risk factors for the prognosis of gastric cancer patients,and postoperative adjuvant chemotherapy(P=0.043)was a protective factor for the prognosis of gastric cancer patients.Conclusion Cancer nodules are closely related to the tumor stage and prognosis of gastric cancer patients.The number of cancerous nodules is an independent risk factor for the prognosis of gastric cancer patients.