伴血小板增多胃癌患者临床病理特征及预后因素分析

目的 分析伴血小板（platelets，PLT）增多胃癌患者临床病理特征及预后的影响因素。 方法 回顾性分析2013年1月至2015年1月在我院接受手术治疗胃癌患者的临床病理资料，并探讨影响患者预后的因素。依据患者术前PLT水平分为观察组（PLT≥400×10⁹/L）51例和对照组（PLT＜400×10⁹/L）49例。结果 观察组肿瘤大小＞5 cm、临床TNM分期Ⅲ期的患者比例高于对照组（P＜0.05）。两组患者在组织类型、肿瘤分化程度、是否合并血管癌栓、有无淋巴结转移等方面比较，差异均无统计学意义（P＞0.05）。观察组患者凝血酶原时间（prothrombin time，PT）显著低于对照组（P＜0.05），而D-二聚体（d-dimer，D-D）及纤维蛋白原（fibrnogen，FIB）水平显著高于对照组（P＜0.05）。观察组术后2年生存率显著低于对照组（64.71% vs 83.67%，χ²＝4.439，P=0.035）。单因素分析显示肿瘤大小、临床TNM分期、伴血小板增多、年龄、术后辅助化疗可能与患者预后有关（P＜0.05）；多因素分析显示，临床TNM分期（HR＝1.135，95% CI：1.077~1.196，P＜0.001）、伴PLT增多（HR＝1.443，95%CI：1.298~1.604，P＜0.001）是影响胃癌患者预后的独立危险因素，而术后化疗（HR＝0.822，95%CI：0.754~0.896，P＜0.001）则是保护因素。结论 伴PLT增多是影响胃癌患者预后的独立危险因素，伴PLT增多胃癌患者可能存在凝血功能障碍，肿瘤进展更快。

Analysis of the pathological features and prognostic of patients with gastric carcinoma and thrombocytosis

Objective Our study aimed to analyze the pathological features and prognostic factors of patients with gastric carcinoma with thrombocytosis. Methods Clinical data were analyzed for gastric carcinoma patients treated at our hospital from 2013 to 2015. A total of 100 patients were divided into two groups depending on whether they suffered from thrombocytosis：Group A，51（PLT≥400×10⁹/L） and Group B，49 （PLT ＜400×10⁹/L）. The prognostic factors were analyzed by multivariate Cox regression. Results Group A patients had higher percentage of tumors with diameter >5 cm and later tumor stage than Group B （P＜0.05）. Type of organization，histological differentiation，vascular tumor emboli and lymph node metastasis did not differ significantly between the groups（P＞0.05）. Group A patients had lower levels of PT，and higher levels of D-D and FIB than Group B patients （P＜0.05）. Group A showed lower 2-year survival rate （64.71% vs 83.67%，χ²=4.439，P=0.035）. Univariate analysis identified tumor size，tumor stage，platelet increase，age，and postoperative adjuvant chemotherapy as independent prognostic factors. Multivariate analysis identified clinical stage（HR=1.135，95%CI：1.077~1.196，P＜0.001），thrombocytosis（HR=1.443，95%CI：1.298~1.604，P＜0.001）and postoperative chemotherapy（HR=0.822，95%CI：0.754~0.896，P＜0.001） as independent prognostic factors of gastric cancer patients. Conclusions Thrombocytosis is an independent risk factor for the prognosis of patients with gastric cancer. Gastric carcinoma combined with thrombocytosis indicates poor prognosis.