进展期胃癌根治术后复发的预后分析

Prognosis of patients with recurrence after curative resection of advanced gastric cancer

目的探讨进展期胃癌根治术后复发患者的预后影响因素。方法对2001年1月至2005年1月收治的进展期胃癌根治术后复发的163例患者进行回顾性研究．根据诊断复发时患者有或无临床症状及体征，分为症状复发组和无症状复发组。结果症状复发组72例．无症状复发组91例。两组患者的淋巴结分期差异有统计学意义（P〈0．05）。无症状复发组中位总体生存期为19．8个月，显著长于症状复发组的15．7个月（P〈0．05）；无症状复发组复发后中位生存期为9．5个月，显著长于症状复发组的4．8个月（P〈0．01）。症状复发组的中位无复发间期为10．0个月．长于无症状复发组的9．2个月（P〈0．05）。单因素分析结果显示，胃癌术后化疗（P〈0．05）、复发类型（P〈0．01）、临床分期（P〈0．01）、无复发间期（P〈0．05）和复发后手术（P〈0．01）是影响胃癌复发患者预后的主要因素；多因素分析结果显示，临床分期（P〈0．01）、复发类型（P〈0．01）、无复发间期（P〈0．05）和复发后手术（P〈0．05）是影响胃癌复发患者预后的独立因素。结论胃癌复发患者的预后较差．胃癌术后2年内是检测随访的重点，积极行再手术治疗有助于延长患者的生存时间。

Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods Clinical data of 163 patients with recurrent gastric cancer from Jan. 2001 to Jan. 2005 were reviewed. Patients were compared between those with and without symptoms. Results Seventy-two patients（44.2%） were symptomatic, while 91 （55.8%）were asymptomatic. There were significant differences in lymph node metastasis between the two groups （P〈0.05）. The median overall survival was significantly longer in asymptomatic patients （19.8 vs. 15.7 months, P〈0.05）. Post-recurrence survival was also longer in the asymptomatic group （9.5 vs. 4.8 months, P〈0.01）. The median recurrence-free interval in asymptomatic patients was 10.0 months, which was significantly longer than that in the symptomatic patients （9.2 months, P〈0.05）. On univariate survival analysis, post-gastrectomy chemotherapy （P〈0.05）, symptoms of recurrence （P〈0.01）, TNM staging （P〈0.01）, recurrence-free interval （P〈0.01）, and reoperation （P〈0.01） were associated with the prognosis. On muhivariable analysis, TNM staging （P〈0.01）, symptoms of recurrence （P〈0.01）, recurrence-free interval （P〈0.05）, and reoperation（P〈0.05） were independent risk factors. Conclusions Patients with recurrent gastric cancer have poor prognosis. Close monitoring and active follow-up of patients with gastric cancer should be conducted during the first two years after operation. Reoperation may improve survival in patients with recurrent gastric cancer.