贲门癌瘤体最长直径与临床病理特征的关系及其对患者生存期的影响

Relationship between Cardia Tumors with A Maximum Diameter and Clinicopathological Features and Impact of Tumors on Survival

目的探讨贲门癌瘤体最长直径(maximum tumor diameter,MTD)与浸润程度、淋巴结转移和分化程度的关系及其对患者生存期的影响,为贲门癌临床病理TNM分期提供依据。方法测量4826例手术治疗的贲门癌患者MTD,分析MTD与肿瘤浸润程度、淋巴结转移和分化程度的关系;对其中1 756例患者进行入户问卷调查、和(或)电话随访,采用Kaplan-Meier法计算其生存期并绘制生存曲线,Log rank检验分析组间生存期的差异,Cox比例风险回归模型分析MTD对患者生存期的影响。结果 4 826例贲门癌患者平均MTD为(5.6±2.3)cm,MTD中位数为5.0 cm(0.5~18.0 cm)。依MTD长度,将贲门癌患者分为四组(MTD【3 cm、3~6 cm、≥6~9 cm、≥9 cm)。随MTD增长,患者淋巴结转移阳性率明显升高(r=0.254,P【0.05),浸润程度逐渐加深(r=0.102,P【0.05),癌细胞分化程度变差(r=0.069,P【0.05);5年生存率明显降低(P【0.05)。特别需要指出的是,随MTD增长,淋巴结转移阴性组患者5年生存率也明显降低。Cox多因素生存分析发现,MTD、淋巴结转移、浸润程度和分化程度是影响贲门癌患者预后的独立因素。结论贲门癌MTD与淋巴结转移、肿瘤细胞浸润程度和分化程度密切相关;是影响贲门癌患者预后的独立因素。

Objective To investigate the relationship between the maximum tumor diameter(MTD) and lymph node metastasis, cancer cell invasion and differentiation degree,and the effects of MTD on the survival of gastric cardia adenocarcinoma(GCA), and to improve TNM staging of GCA.Methods MTD was examined in resected GCA specimens from 4 826 cases with GCA. All of 1 756 cases were follow-up by interview and questionnaires at home and(or) telephone communication.Kaplan-Meier,Log-rank test and Cox proportional hazard model was used to analyze the difference of survival.Results The mean and the median MTD of 4 826 cases were(5.6±2.3) cm and 5.0 cm(0.5-18.0 cm),respectively.Based on MTD, GCA patients were divided into four groups(MTD<3 cm, ≥3-6 cm, ≥6-9 cm, ≥9 cm). With MTD increasing, the positive rate of lymph node metastasis, and the invasion depth became incraesed signifi cantly(r=0.254 and 0.102,P<0.05), but differentiation degree decreased gradually(r=0.069,P<0.05); Furthermore, the fi ve-year survival rate was lower signifi cantly(P<0.05). It was noteworthy that, even in GCA patients with negative lymph node metastasis, the increased MTD was related to the shorter fi ve-year survival. Cox multivariate survival analysis found that MTD,lymph node metastasis, cancer cell invasion and differentiation degree were independent factors for the prognosis. Conclusion Lymph node metastasis, cancer cell invasion and differentiation degree were independent risk factors for the prognosis of GCA.