贲门癌根治术后患者预后的多因素分析

Multivariate prognostic analysis for patients with curative resection of gastric cardla cancer

目的探讨贲门癌根治术后患者预后的影响因素。方法通过回顾性分析我院1994年7月至2003年12月间行根治性手术治疗并有完整随访资料的108例贲门癌患者的临床病理资料,探讨影响贲门癌预后的相关因素。结果108例患者中,SiewertⅡ型占68例,Ⅲ型占40例；淋巴结转移率为68．5%(74/108)。本组患者随访至2004年12月,平均生存时间为37个月(95%CI为29．3～44．7月),中位生存时间为26．6个月；1、3和5年生存率分别为77．2%、33．6%和21．8%。单因素分析结果显示,是否行脾切除术、肿瘤大小、肿瘤浸润深度及淋巴结转移情况是影响患者预后的因素。多因素分析结果显示,仅肿瘤浸润深度(P=0．009)及淋巴结转移情况(P=0．001)是影响患者预后的独立因素,OR值分别为2．373(95%CI为1．474～16．212)和2．269(95%CI为1．450～4．997)。结论贲门癌根治术后患者的预后与肿瘤浸润深度及淋巴结转移数目呈负相关。脾脏未受侵犯时应予以保留,全胃切除未能改善贲门癌根治术后患者的预后。

Objective To explore the factors affecting the long-term survival of patients with curative resection of gastric cardia cancer. Methods The data of 108 patients who underwent radical resection of gastric cardia cancer from Jul. 1994 to Dec. 2003 in our hospital were investigated retrospectively. The Kaplan-Meier method and long-rank test were used for bivafiate comparisons of survival. Multivariate analysis was done by the Cox regression model （Backward Wald）. Results Survival status of the 108 patients was ascertained in Dec. 2004. Among them, 68 were Siewert type Ⅱ and 40 were Siewert type Ⅲ. Seventy-four patients had lymph node metastases （68.5%）. The mean follow-up time was 37 months （95%CI：29.3-44.7 months） and the middle follow-up time was 26.6 months（95%CI：25.8-34.2 months）. The 1-, 3- and 5-year cumulative survival rates were 77.2%, 33.6% and 21.8%, respectively. According to the Kaplan-Meier and log-rank methods, splenectomy, lesion size, depth of tumor invasion and regional lymph node status were prognostic factors. Multivariate regression analysis indicated that only depth of tumor invasion （P = 0.009） and lymph node metastases （P = 0.001） were independent prognostic factors. Conclusion Depth of tumor invasion and lymph node metastases have negative effects on the survival of patients with gastric cardia cancer undergoing curative resection. Splenectomy may only be appropriate for patients with direct tumor invasion to the spleen and the extent of gastric resection does not influence survival in patients with curative gastric cardia cancer.