胃癌腹膜转移的临床病理特性及预后分析

目的 探讨胃癌腹膜转移(P2)的临床病理特性及不同术式对预后的影响。方法 对91例P2患者的临床病理资料及不同术式术后生存情况进行回顾性分析。结果 单因素分析发现,肿瘤大小、肿瘤部位、分化程度、Borrmann分型、脏器侵犯、淋巴结转移、浸润深度、肝转移与P2相关(P＜0.05)。Logistic回归分析显示,浸润深度和脏器侵犯是P2独立的影响因素(P＜0.05)。非根治切除术组和姑息手术组在年龄、腹水及脏器侵犯上差别有统计学意义(P＜0.05)。姑息手术组中造瘘术、胃肠吻合术与剖腹探查术间的生存时间差别无统计学意义(P＞0.05)。非根治切除术组的中位生存时间为13.4月,姑息手术组的中位生存时间为4.2月,差别有统计学意义(P＜0.01),Cox分析显示手术方式和肿瘤大小是影响P2患者预后的独立危险因素。结论 胃癌患者的临床病理特征与腹膜转移的发生密切相关,非根治切除术可改善胃癌腹膜转移(P2)患者的预后。

The analysis of clinicopatholgic features and prognosis in gastric cancer with Peritoneal dissemination

Objective To investigate the clinicopathologic features of gastric cancer with peritoneal dissemination, and also to evaluate the impact of different operations on the prognosis. Methods A statistical analysis was performed retrospectively with regard to elinicopathologic features and survival of 91 cases of gastric cancer with peritoneal dissemination. Results Univariate analysis revealed that tumor size, tumor location, degree of differentiation, Borrmann types ,organ infiltration, lymph node metastasis, depth of invasion and hepatic metastasis were correlated with Peritoneal dissemination （P 〈 0.05 ）. The Logistic regression model revealed that the depth of invasion and organ infiltration were independent factors （ P 〈 0.05 ）. The difference of age, ascites and organ infiltration between the non -radical resection and palliative operation groups was statistically significant（ P 〈 0.05 ）. The different survival time of palliative operation group with feeding neostomy, gastrointestinal anastomosis and exploratory laparotomy was not statistically significant（ P 〉 0.05 ）. The median survival time in non -radical resection group was 13.4 months and in palliative operation group was 4.2 months. The difference was statistically significant（ P 〈 0.01 ）. Multivariate analysis by Cox regression indicated that the type of operation and tumor size were significant factors affecting the prognosis of the patients with peritoneal dissemination. Conclusions The clinicopathologic features of patients with gastric cancer are intimately correlated with peritoneal dissemination. Non - radical resection can improve the prognosis of peritoneal dissemination patients of gastric cancer.