胃癌R0切除上下切缘距离与预后的相关性研究

目的 探讨R0切除且无远处转移胃癌患者上下切缘距离与预后的关系.方法 选取2008年1月至2009年11月无远处转移、接受胃癌根治术、术后病理检查确诊为胃腺癌且切缘肿瘤无残留、临床病理和随访资料完整的288例胃癌患者为研究对象.整理临床病理指标并分析不同上切缘(proximal resection margin,PRM)距离、下切缘(distal resection margin,DRM)距离与临床病理指标的相关性,多因素分析胃癌预后相关独立危险因素,分析不同PRM、DRM距离与胃癌术后生存的关系.结果 PRM距离增大与病灶位于胃下1/3显著相关(P＜0.001);DRM距离增大与肿瘤T分期较早(P=0.044 2)、病灶位于胃中1/3 (P=0.008 4)、病灶较小(P=0.024 1)、术前血清肿瘤标记物正常(P=0.013 2)和全胃切除术(P=0.001 7)相关.单因素分析提示:PRM距离(P=0.650)及DRM距离(P=0.095)不是影响胃癌生存的主要因素,PRM距离及DRM距离在局部区域复发与远处复发间差异无统计学意义.多因素分析提示:N分期、病灶部位、病灶大小、淋巴管侵犯是胃癌预后的独立危险因素;不同PRM距离(P=0.650)、DRM距离(P=0.095)对胃癌生存的影响差异无统计学意义.亚组分析结果提示:PRM距离对N0+N1组内生存的影响差异无统计学意义(P=0.312),而DRM距离对于N0 +N1组内生存的影响差异有统计学意义(P=0.011).结论 PRM、DRM距离并非影响胃癌术后生存的独立危险因素,但是DRM距离＞2 cm在淋巴结转移数目＜3个的胃癌患者中能显著改善R0切除术后预后.

Association of proximal, distal resection margin distances in R0 gastrectomy with prognosis of gastric cancer

Objective To investigate the association of proximal and distal resection margin (PRM/DRM) distances in R0 gastrectomy with the prognosis of gastric cancer patients with no distant metastases. Methods From Jan. 2008 to Nov. 2009, a total of 288 patients with gastric cancer were selected; they received radical and R0 gastrectomy, with pathological diagnosis after surgery and with complete pathological and follow-up data. The relationship of the pathological parameters with the PRM, DRM distance was analyzed. Univariate and multivariate analyses were performed to indentify the independent risk factors of prognosis and to evaluate the association between PRM, DRM distance and overall survival (OS). Results Increased PRM distance was significantly correlated with tumor location at the lower third of the stomach (P<0.001). Increased DRM distance was significantly correlated with an early T-stage (P=0.044 2), tumor location at the middle third of stomch (P=0.008 4), smaller tumor size (P=0.024 1), normal preoperative serum markers (P=0.013 2) and total gastrectomy (P=0.001 7). Univariate analysis showed that PRM distance (P=0.650) and DRM distance (P=0.095) were not significantly correlated with gastric cancer survival, and they did not significantly influence locoregional recurrence or distant recurrence. Multivariate analysis showed that the independent prognostic factor for gastric cancer included N-stage, tumor location, tumor size, and presence of lymphatic invasion; also PRM distance (P=0.650) and DRM distance (P=0.095) had no significant influence on the survival of gastric cancer patients. Subgroup analysis showed that PRM distance had no significant influence on the overall survival (P=0.312) in N-stage N₀+N₁ group, but DRM distance had significant difference on the overall survival (P=0.011) in N₀ N₁ group. Conclusion PRM and DRM distance are not the independent risk factors for the overall survival of gastric cancer patients undergoing R0 gastrectomy. DRM distance of more than 2 cm can markedly improve the prognosis of the patients with less than 3 metastatic lymph nodes.