影响根治术后胃癌预后的多因素分析

Multivariate Prognostic Analysis in Gastric Carcinoma Patients after Radical Operation

背景与目的:能否行根治性手术切除是影响胃癌预后的重要因素,但施行根治性手术的胃癌患者的远期疗效不尽相同。本研究的目的就是探讨影响胃癌预后的有关因素。方法:回顾性分析我院1985年1月～1995年12月收治的全部行胃癌根治性手术的405例患者的临床资料,采用生命表法进行生存率分析,W ilcoxon秩和检验进行统计学比较,应用Cox比例风险模型进行多因素分析。结果:全组总的5年生存率为43.4%;术后病理分期(pathological TNM,pTNM)Ⅰ、Ⅱ、Ⅲ、Ⅳ期的患者5年生存率分别为75.6%、58.7%、28.0%、18.4%(P<0.01);肿瘤大小<2.0cm、2.0～3.9cm、4.0～5.9cm、6.0～7.9cm、≥8.0cm组的患者5年生存率分别为82.0%、57.4%、43.7%、38.7%、26.9%(P<0.05);有、无辅加围手术期化疗的患者5年生存率分别为47.2%和37.8%。单因素分析表明,围手术期化疗、Borrm ann分型、肿瘤大小、组织学类型、pTNM分期是影响胃癌预后的相关因素。多因素分析显示,pTNM分期、肿瘤大小及围手术期化疗是影响胃癌预后的独立因素。结论:pTNM分期、肿瘤大小及围手术期化疗是影响胃癌根治术预后的最重要因素;施行以手术为中心的围手术期化疗,有助于提高胃癌患者的生存率。

BACKGROUND & OBJECTIVE: Whether received radical operation is an important prognostic factor of gastric carcinoma. But the long-term efficacies of radical operation on different patients are not the same. This study was to investigate prognostic factors of gastric carcinoma. METHODS: Clinical data of 405 patients with gastric carcinoma, received radical operation from Jan. 1985 to Dec. 1995 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Life table method was used to analyze survival rate, Wilcoxon test was used for statistical comparison, and Cox regression model was used for multivariate analysis. RESULTS: The 5-year overall survival rate was 43.4%. The 5-year survival rates of patients in pathologic TNM (pTNM) stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ were 75.6%, 58.7%, 28.0%, and 18.4%, repectively (P < 0.01). The 5- year survival rates of patients with tumor sizes of less than 2.0 cm, 2.0-3.9 cm, 4.0-5.9 cm, 6.0-7.9 cm, and no less than 8.0 cm were 82.0%, 57.4%, 43.7%, 38.7%, and 26.9%, respectively (P < 0.05). In addition, the 5-year survival rate was higher in patients with perioperative chemotherapy than in patients without perioperative chemotherapy (47.2% vs. 37.8%, P < 0.05). Univariate analysis showed that perioperative chemotherapy, Borrmann type, tumor size, pathologic type, and pTNM stage were prognostic factors of gastric carcinoma. Multivariate analysis showed that pTNM stage, tumor size, and perioperative chemotherapy were independent prognostic factors of gastric carcinoma. CONCLUSIONS: pTNM stage, tumor size, and perioperative chemotherapy are the most significant factors influencing prognosis of gastric carcinoma patients after radical operation. Perioperative chemotherapy contributes to enhance survival rate of gastric carcinoma patients.