摘要
目的探讨pT1N3M0期胃癌患者的临床病理特征及预后影响因素.方法回顾性分析2010-2019年河北医科大学第四医院外三科收治的110例术后病理分期为pT1N3M0期患者的临床病理特征及影响预后的危险因素.结果110例pT1N3M0期胃癌患者中pT1aN3aM0期27例(24.5%),pT1aN3bM0期10例(9.1%),pT1bN3 aM0期45例(40.9%),pT1bN3bM0期28例(25.5%);病灶位于贲门-胃底51例(46.4%),胃体-胃窦59例(53.6%);病灶直径≥2 cm者40例(36.4%),<2cm者70例(63.6%);高~中分化腺癌59例(53.6%),低~未分化腺癌51例(46.4%).全组患者中有104例(94.5%)获得随访,2年总生存率(OS)为63.5%,2年无病生存率(DFS)为57.7%,其中各组2年OS分别为92.0%、50.0%、70.7%、30.8%,2年DFS分别为88.0%、41.7%、65.9%、23.1%,各组2年OS和DF3相比差异均有统计学意义(均P<0.05).单因素分析显示,患者年龄、肿瘤直径、浸润深度T分期、组织学类型、淋巴结转移N分期、肿瘤标记物CA19-9、CA72-4表达水平、脉管瘤栓、神经受侵、Ki67阳性比例及Lauren分型均与pT1N3M0期胃癌患者的预后有关(均P<0.05).多因素分析显示,肿瘤病灶直径≥2 cm(P=0.003)、肿瘤组织类型差(P=0.004)、淋巴结分期为N3b期(P=0.000)、同时合并脉管瘤栓(P=0.001)及神经受侵(p=0.002)均是影响pT1N3M0期胃癌患者预后的独立危险因素.结论pT1N3M0期胃癌患者预后较差,淋巴结转移N分期为N3b期是影响预后的独立危险因素.
Objective To explore the clinicopathological features and prognostic factors of gastric cancer patients with pathological stage T1N3M0(pT lN 3M 0)according the TCC staging criteria of the 8th edition of UICC.Methods We retrieved the clincal data from the Third Department of Surgery,the Fourth Hospital of Hebei Medical University from 2010 to 2019 for pTlN3M0 patients,and analyzed the clinical and pathological characteristics affecting the prognosis.Results A total of 110 pTlN3M0 gastric cancer patients were recruited,including 27 cases(24.5%)at pTlaN3aM0 stage,10 cases(9.1%)of pTlaN3bM 0,45 cases(40.9%)of pTlbN3aM 0,and 28 cases(25.5%)of pTlbN3bM0.Tumors were located in the cardia-gastric fundus in 51 cases(46.4%),in body antrum in 59 cases(53.6%);In 40 cases(36.4%)with lesion diameter<2 c m,in 70 cases(63.6%)the lesion<2 cm;59 cases(53.6%)were with highmedium differentiated adenocarcinoma,51 cases(46.4%)with low undifferentiated adenocarcinoma.104 patients(94.5%)were followed up.The 2-year overall survival rate(OS)was 63.5%,and the 2-year disease-free survival rate(DFS)was 57.1%.Counting seperately the 2-year OS was 92.0%,50.0%,70.7%,and 30.8%;and the 2-year DFS was 88.0%,41.1%,65.9%,and 23.1%,respectively in the 4 respective groups.The differences in 2-year OS and DFS between the groups were statistically significant(all P<0.05).Univariate analysis showed that the patient's age,tumor diameter,infiltration depth(T stag e),histological type,lymph node metastasis(N stag e),tumor marker CA19-9,C A 72-4,tumor vascular thrombus and nerve invasion,Ki67 and Lauren classification were related to the prognosis(all P<0.05).Multivariate analysis showed that tumor size≥2cm(P=0.003),poor tumor tissue type(P=0.004),N3b stage(P=0.000),tumor vascular thrombus(P=0.001)and nerve invasion(P=0.002)is an independent risk factor affecting the prognosis of pTlN3M0 gastric cancer patients.Conclution Patients with pTlN3M0 stage gastric cancer have a poor prognosis,arui the N3b stage is an independent risk factor affecting the prognosis.
作者
丁平安
杨沛刚
田园
刘洋
郭洪海
张志栋
王冬
赵群
Ding Ping'an;Yang Peigang;Tian Yuan;Liu Yang;Guo Honghai;Zhang Zhidong;Wang Dong;Zhao Qun(Department of General Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2020年第8期598-602,共5页
Chinese Journal of General Surgery
基金
河北卫健委县级公立医院适宜卫生技术推广入库项目(2019024)。
关键词
胃肿瘤
淋巴转移
肿瘤分期
预后
危险因素
Stomach neoplasms
Lymphatic metastasis
Neoplasm staging
Prognosis
Risk factor
