肿瘤大小对T3期胃癌患者预后的影响

目的探讨肿瘤大小对T3期胃癌患者预后的影响。方法对408例L期胃癌患者施行胃癌D2根治术，应用Cox比例风险模型对肿瘤大小进行最佳截点的筛选。对全组T3期胃癌患者的预后因素进行单因素及多因素分析：并对大直径组及小直径组胃癌患者的预后因素进行多因素分析。结果本组408例T3期胃癌患者通过Cox比例风险模型筛选出肿瘤大小的最佳截点为8cm。肿瘤大于或等于8cm的胃癌患者（大直径组）85例．小于8cm的胃癌患者（小直径组）323例：大直径组和小直径组术后5年生存率分别为33．8％和52．2％，差异有统计学意义（P〈0．05）。通过Cox比例风险模型分析显示，肿瘤大小、淋巴结转移、Boi Tmann分型和肿瘤部位是影响全组患者预后的独立因素（均P〈0．01）：进一步按肿瘤大小进行分层预后分析显示，Borrmann分型和淋巴结转移是影响大直径组患者预后的独立因素（均P〈0．05）；淋巴结转移是影响小直径组患者预后的独立因素（P〈0．01）。结论以8cm为界值进行B期胃癌患者的预后判断准确性最高。肿瘤大小是影响B期胃癌患者预后的独立因素。

Prognostic significance of tumor size in T3 gastric cancer

Objective To investigate the impact of tumor size on the prognosis of patients with T3 gastric cancer. Methods D2 curative resection was performed on 408 patients with T3 gastric cancer. Cox proportional hazards model was used to identify the optimal cut-off of tumor size. Potential prognostic factors were evaluated by univariate and multivariate analysis. Multivariate analysis was performed to evaluate the prognostic factors straitified by tumor size. Results Among 408 patients with T3 gastric cancer, Cox proportional hazards model showed that 8 cm was the optimal cut-off of tumor size. There were 85 patients with tumor size ≥ 8 cm (large size group), and 323 patients with tumor size ＜ 8 cm (small size group). The 5-year survival rate was significantly lower for patients with small size tumor (33.8% vs. 52.2%, P＜0.05). Cox proportional hazards model showed that lymph node metastasis, tumor size, and Borrmann type were independent prognostic factors for the entire cohort.Borrmann type Ⅳ and N2-3 nodal metastasis were independent prognostic factors for the large size group. Lymph node metastasis was independent prognostic factor for the small size group.Conclusions Tumor size is an independent prognostic factor in patients with T3 gastric cancer. Lymph node metastasis is a significant predictor for the prognosis regardless of tumor size. Furthermore,Borrmann classification is associated with the prognosis in patients with tumor size ≥ 8 cm.