上三分之一胃癌临床病理特征的分析

目的探讨影响上三分之一胃癌(upper third of gastric cancer,UTGC)病人总生存率(overall survival rate,OS)、淋巴结转移和复发的预后因素。方法回顾性分析126例接受根治性手术治疗联合化疗UTGC病人的临床病理资料,通过Kaplan-Meier分析确定了OS和单变量分析,并用对数秩检验计算了曲线间差异的显著性。采用Cox比例风险回归模型进行多变量分析,采用受试者操作特性曲线分析来确定预后的准确性。结果UTGC病人1、3、5年的OS分别为81.0%、47.6%和38.6%;单变量分析显示肿瘤大小(P=0.019)、肿瘤浸润深度(P<0.001)和淋巴结转移(P<0.001)是5年OS的危险因素;多变量分析确定肿瘤浸润深度(P<0.001)和淋巴结转移(P<0.001)是UTGC病人5年OS的独立预后因素,对于有淋巴结转移的UTGC病人,肿瘤大小(P=0.023)、肿瘤浸润深度(P=0.002)和浆膜浸润(P=0.004)是5年OS的危险因素;多变量分析确定肿瘤大小(P=0.048)、肿瘤浸润深度(P=0.004)和浆膜浸润(P=0.031)是5年OS的独立预后因素,对于有远处转移或肿瘤复发的UTGC病人,单变量和多变量分析显示肿瘤浸润深度和淋巴结转移是5年OS的独立预后因素。结论对于接受根治性手术治疗的UTGC病人,肿瘤浸润深度和(或)淋巴结转移是5年OS、远处转移和肿瘤复发的独立预后因素。

Analysis of clinicopathological features of the upper third of gastric cancer after radical operation

Objective To investigate the prognostic factors affecting overall survival rate(OS),lymph node metastasis and recurrence in patients with upper third of gastric cancer(UTGC). Methods The clinicopathologic data of126 UTGC patients treated with radical surgery and combined chemotherapy were retrospectively analyzed. OS and univariate analysis were determined by Kaplan-Meier analysis,and the significant differences between curves were calculated by log-rank rank test. Multivariate analysis was performed using the Cox proportional hazards regression model,and receiver operating characteristic curve analysis was used to determine the prognostic accuracy. Results OS of UTGC patients at one year,three years and five years were 81.0%,47.6% and 38.6%,respectively. Univariate analysis showed that tumor size( P =0.019),depth of invasion( P < 0.001)and lymph node metastasis( P <0.001)were risk factors for the 5-year OS. Multivariate analysis identified depth of tumor invasion( P < 0.001)and lymph node metastasis( P < 0.001)as independent prognostic factors for 5-year OS of UTGC patients( P < 0.001). For UTGC patients with lymph node metastasis,tumor size( P = 0.023 ),depth of tumor invasion( P =0.002)and serosal infiltration( P =0.004)were risk factors for the 5-year OS. For UTGC patients with distant or recurrent tumors,univariate and multivariate analysis identified depth of tumor invasion and lymph node metastasis as independent prognostic factors for 5-year OS. Conclusion The depth of tumor invasion and/or lymph node metastasis are independent prognostic factors for 5-year OS,lymph node metastasis,distant metastasis,and tumor recurrence in patients with UTGC undergoing curative surgery.