性别与贲门腺癌术后患者预后相关性研究

目的目前,国内外关于性别与贲门腺癌(gastric cardia adenocarcinoma,GCA)患者术后预后的研究鲜有报道。本研究探讨性别是否与GCA患者的预后有关。为GCA患者的治疗提供最优方案,延长其生存期。方法回顾性分析郑州大学第一附属医院省部共建食管癌防治国家重点实验室500×10~3例食管癌和贲门癌临床信息数据库中行贲门癌根治术的5968例GCA患者临床资料,采用Kaplan-Meier法计算患者的累积生存率,并绘制生存曲线,组间比较用Log-rank检验。多因素Cox比例风险回归模型方法分析预后主要影响因素。结果本研究5968例患者中男性中位总生存期(median overall survival,mOS)为3.871年,女性为4.274年,差异有统计学意义,χ^2=21.396,P<0.001。单因素分析显示,年龄(χ^2=47.863,P<0.001)、分化程度(χ^2=59.517,P<0.001)、切缘状况(χ^2=12.198,P<0.001)、TNM分期(χ^2=470.929,P<0.001)均是GCA患者预后的影响因素,结果显示在年龄(<55岁,χ^2=5.749,P=0.016;≥55岁,χ^2=15.462,P=0.001)、高低发区(低发区,χ^2=8.218,P=0.004;高发区,χ^2=13.462,P=0.001)、分化程度(低分化,χ^2=8.144,P=0.004;中分化,χ^2=7.060,P=0.008;高分化,χ^2=5.422,P=0.020)、切缘状况(净,χ^2=16.010,P=0.001;不净,χ^2=7.193,P=0.007)、TNM分期(Ⅱ期,χ^2=11.760,P<0.001;Ⅲ期,χ^2=13.331,P<0.001)上女性生存均优于男性。多因素分析显示,性别(OR=1.209,95%CI为1.120~1.304)、年龄(OR=1.349,95%CI为1.240~1.469)、分化程度(中分化,OR=1.174,95%CI为1.046~1.317;低分化,OR=1.093,95%CI为0.976~1.224)、切缘状况(OR=1.167,95%CI为1.048~1.299)、TNM分期(Ⅱ期,OR=1.823,95%CI为1.423~2.337;Ⅲ期,OR=3.518,95%CI为2.752~4.497)是影响GCA患者预后的独立影响因素。调整混杂因素后进一步多因素分层分析提示,年龄(OR=1.312,95%CI为1.191~1.445)、中分化(OR=1.155,95%CI为1.010~1.322)、切缘状况(OR=1.241,95%CI为1.100~1.400)、TNM分期(Ⅱ期,OR=1.832,95%CI为1.398~2.401;Ⅲ期,OR=3.535,95%CI为2.707~4.617)是男性GCA患者预后的独立影响因素;年龄(OR=1.470,95%CI为1.231~1.754)、TNM分期(Ⅲ期OR=3.692,95%CI为1.970~6.918)是女性GCA患者预后的独立影响因素。结论性别为GCA患者预后的独立影响因素,女性患者的生存期明显优于男性患者。且不同性别GCA患者预后的独立影响因素不同。

Correlation between gender and prognosis of gastric cardia adenocarcinoma patients

OBJECTIVE At present,there are few reports about gender and prognosis of patients with gastric cardia adenocarcinoma(GCA)at home and abroad.The purpose of this study was to explore whether gender is related to the prognosis of patients with GCA,to provide optimal treatment for GCA patients and prolong their survival.METHODS The clinical data of 5968 patients with GCA who underwent radical operation in the clinical information database of 500×10~3 cases of esophageal cancer and GCA in Henan Key Open Laboratory of the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The cumulative survival rate of the patients was calculated with the method of Kaplan-Meier,and the survival curve was drawn.Log rank test was used for comparison between groups.Cox proportional risk regression model was used to analyze the main prognostic factors.RESULTS The median survival of male patients in this group was 3.871 years,and 4.274 years in women.The difference was statistically significant(χ^2=21.396,P<0.001).The single-factor analysis showed that age(χ^2=47.863,P<0.010),degree of division(χ^2=59.517,P<0.001),incisal margin status(χ^2=12.198,P<0.001),TNM staging(χ^2=470.929,P<0.001)were all factors of prognosis in patients with GCA;Single-factor stratified analysis illustrated that woman’s survival time is longer than that of men in age(<55 years old:χ^2=5.749,P=0.016;≥55 years old:χ^2=15.462,P=0.001),high-incidence area(HIA)and low-incidence area(LIA:χ^2=8.218,P=0.004;HIA:χ^2=13.462,P=0.001),degree of differentiation(low differentiation:χ^2=8.144,P=0.004;medium-differentiated:χ^2=7.060,P=0.008;high-differentiation:χ^2=5.422,P=0.020),incisal margin(net:χ^2=16.010,P=0.001;non-net:χ^2=7.193,P=0.007)and TNM staging(Ⅱ:χ^2=11.760,P<0.001;Ⅲ:χ^2=13.331,P<0.001).Multi-factor analysis proved that gender(OR=1.209,95%CI1.120-1.304),age(OR=1.349,95%CI1.240-1.469),degree of differentiation(in-differentiated OR=1.174,95%CI1.046-1.317,low differentiation OR=1.093,95%CI0.976-1.224),incisal margin(OR=1.167,95%CI1.048-1.299),and TNM staging(Ⅱ:OR=1.823,95%CI1.423-2.337;Ⅲ:OR=3.518,95%CI2.752-4.497)were all independent influential factors affecting the prognosis of patients with GCA.After adjusting the promiscuous factors,further multi-factor layering analysis suggested that age(OR=1.312,95%CI1.191-1.445),medium differentiation(OR=155,95%CI1.010-1.322),incisal margin(OR=1.241,95%CI1.100-1.400),TNM staging(Ⅱ:OR=1.832,95%CI1.398-2.401;Ⅲ:OR=3.535,95%CI2.707-4.617)were independent factors influencing the prognosis of male patients with GCA;While age(OR=1.470,95%CI1.231-1.754),TNM staging(Ⅲ:OR=3.692,95%CI1.970-6.918)were ones for females.CONCLUSIONS Gender is an independent prognostic factor in patients with CCA.The survival time of female patients was significantly longer than that of male patients.The independent influencing factors of prognosis vary in different genders.