摘要
目的:探讨进展期胃癌根治术后早期发生复发转移的影响因素,以及Ki-67表达与临床病理参数间相关性及对预后的影响。方法:回顾性分析2007-01-01-2011-08-31中国医科大学附属第四医院行根治术的128例胃癌患者临床资料,分为早期复发组(62例)和对照组(66例),进行临床病理参数比较,应用Cox模型分析独立影响因素。分析Ki-67与各临床病理参数关系,运用Kaplan-Meier法分析其与患者生存时间关系。结果:128例患者中,早期复发组与对照组肿瘤病理分级(χ2=11.170,P=0.004)、大体分型(χ2=7.049,P=0.008)、浆膜浸透(χ2=9.372,P=0.009)、淋巴结转移(χ2=16.516,P<0.001)、pTNM分期(χ2=40.911,P<0.001)、脉管癌栓(χ2=23.944,P<0.001)以及Ki-67表达(χ2=18.011,P<0.001)差异有统计学意义。Ki-67表达与肿瘤大小(χ2=10.383,P=0.016)、浸润深度(χ2=12.674,P=0.049)及淋巴结转移阳性率(P<0.001)存在明显相关性。单因素分析显示,肿瘤的病理分级(χ2=10.013,P=0.007)、浆膜浸润(χ2=11.632,P=0.003)、是否有淋巴结转移(χ2=14.197,P<0.001)、脉管癌栓(χ2=37.532,P<0.001)、pTNM分期(χ2=58.200,P<0.001)、大体分型(χ2=6.251,P=0.012)以及Ki-67表达(χ2=18.961,P<0.001)对肿瘤术后复发时间有影响。多因素分析显示,脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。随着淋巴结转移阳性率增加,其Ki-67的阳性表达率也增加,P<0.001;当Ki-67阳性表达>50%时,患者预后差。结论:脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。Ki-67对于判断胃癌肿瘤生物学行为有一定价值,可作为临床参考指标指导预后。
OBJECTIVE：To investigate the factors associated with early postoperative recurrence after radical surger- y,and evaluate the correlation between the expression of Ki-67 and clinicopathology or prognosis for advanced gastric cancer. METHODS： Complete clinical data of 128 patients who received radical gastrectomy between 2007-01-01 and 2011-08-31 at the Fourth Affiliated Hospital of China Medical University were analyzed. Clinical pathological parameters between the relapse group and the control group were compared, Cox proportional hazards regression was used to analyze independent factors. The correlation between the expression of Ki-67 and clinicopathological was analyzed, and overall sur- vival was estimated with Kaplan-Meier method. RESULTS： Tumor pathology classification（χ^2 = 11.170, P= 0. 004）, gross type（χ^2=0.049,P=0. 008） ,serosa infiltration（χ^2 =9. 372 ,P=0. 009） ,lymph node metastasis（χ^2 = 16. 516,P〈0. 001）, pTNM staging（χ^2=40. 911, P〈0. 001）, lymphovascular（χ^2 = 23. 944, P〈0. 001） and the expression of Ki-67 （ 2 = 18. 011 ,P〈0. 001） were significantly associated with the early relapse group. Ki-67 showed a significant correlation with tumour size（χ^2 = 10. 383 ,P=0. 016）, depth of infiltration （χ^2 = 12. 674, P= 0. 049）and metastatic lymph node ratio （P〈 0. 001）. Univariate analysis showed that pathology classification（χ^2 = 10. 013, P=0. 007）, serosa infiltration（χ^2 = 11. 632,P = 0.003）, lymph node metastasis （ χ^2 = 14.197, P 〈 0. 001 ）, lymphovascular （χ^2 = 37.532, P 〈 0.001 ）, pTNM staging （χ^2 =58. 200,P〈0. 001）,gross type（χ^2 =6. 251,P〈0. 012） and the expression of Ki-67（χ^2 =18. 961,P〈0. 001） were associated with the relapse time after surgery. Multivariate analysis showed that pTNM staging,lymphovascular embolism and Ki-67 were independent prognostic factors for early postoperative recurrence （P〈0.05）. With the increase of lymph node metastasis, the expression of Ki-67 increased. When the Ki-67 positive expression was more than 50 % ,the prognosis of patients was worse （P〈0. 001）. CONCLUSIONS： Ki-67 has positively expressive correlation and may serve as valuable indicator for biological behavior of gastric carcinoma.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2014年第18期1423-1428,共6页
Chinese Journal of Cancer Prevention and Treatment
