BorrmannⅣ型胃癌临床病理特征及预后因素分析

Clinicopathological features and prognostic factors analysis of Borrmann type Ⅳ gastric cancer

目的探讨BorrmannⅣ型胃癌患者的临床病理特征及影响预后因素。方法回顾性分析205例BorrmannⅣ型胃癌患者的临床病理资料,采用Kaplan-Meier法进行生存率计算,各亚组生存率差别的比较采用Log-rank检验,采用Cox比例分析模型作其对生存率影响的多因素分析。结果 BorrmannⅣ型胃癌患者总的1年、3年、5年生存率分别为57.9%、23.0%、13.5%,其根治性切除(R0切除)率为53.2%。单因素分析显示病变部位、大小、腹水、浸润深度、淋巴结转移站别、pTNM分期、胃切除范围、淋巴结清扫、联合脏器切除、根治度、淋巴管癌栓、断端残留、淋巴结转移率与BorrmannⅣ型胃癌预后显著相关(P<0.05)。多因素分析显示pTNM分期、胃切除范围、淋巴管癌栓、断端残留是影响BorrmannⅣ型胃癌患者预后的独立因素(P<0.05)。结论 BorrmannⅣ型胃癌生物学特性独特,恶性程度高,预后差,治疗上尽可能行根治性全胃切除,杜绝切缘残留,对BorrmannⅣ型胃癌患者预后具有重要意义。

Objective To investigate the clinicopathological features of patients with Borrmann type Ⅳ gastric cancer and prognostic factors.Methods Retrospectively analysed the clinical and pathological data of 205 cases with Borrmann type Ⅳ gastric cancer.Survival rate was estimated by Kaplan-Meier method.The prognostic factors were analyzed by univariate（Log rank） and multivariate （Cox model） analysis methods.Results The 1,3,5 year survival rates of patients with Borrmann type Ⅳ gastric cancer were only 57.9%,23.0%,13.5%,respectively,and the radical resection （R0 resection） rate was 53.2%.Univariate analyses showed that tumer location,size,ascites,depth of invasion,lymph node metastasis,pTNM stage,the scope of gastric resection,the lymph node dissection,the combined organ resection,the curability,the cancer embolus,margin situation,the lymph node metastasis rate were related to the pronosis of patients with Borrmann type Ⅳ gastric cancer（P〈0.05）.Multivariate analyses revealed that pTNM stage,the scope of gastric resection,the cancer embolus,surgical margin were the independent prognostic factors for the patients with Borrmann type Ⅳ gastric cancer（P〈0.05）.Conclusions Borrmann type Ⅳ gastric cancer has biological peculiarity,which is a malignant gastric cancer and the prognosis is poor.The treatment as radical resection with total gastrectomy and the surgical margin is negative is of importance to the prognosis of patients with Borrmann type Ⅳ gastric cancer.