根治性切除术后残胃癌的预后分析及与近端胃癌预后的配对比较

Prognostic Analysis of Remnant Gastric Cancer after Radical Resection and Case Control Comparison with Proximal Stomach Cancer

目的:残胃癌与近端胃癌都发生于胃上部黏膜,但由于残胃特殊的内环境,两者临床病理特征与预后有着显著差异。本研究分析了残胃癌的预后影响因素,比较残胃癌与近端胃癌的预后差异。方法:对83例在1991年7月至2008年7月期间在天津市肿瘤医院行根治术的残胃癌患者的临床资料进行预后分析,并与同期83例近端胃癌患者进行回顾性配对对照研究,比较两组预后差异。结果:残胃癌预后单因素分析中肿瘤直径、TNM分期、浸润深度、淋巴结转移是影响残胃癌预后的相关因素(P<0.05);Cox回归中TNM分期及浸润深度(T分期)是影响残胃癌预后的独立因素(P<0.05),TNM分期及T分期越晚预后越差。残胃癌与近端胃癌的配对研究中,残胃癌行联合脏器切除28例,明显高于近端胃癌(P=0.022)。根治性切除术后残胃癌的中位生存期为33.4个月,长于近端胃癌,其1、3、5年生存率分别为90%、49%、22%,亦高于近端胃癌(P=0.042)。结论:临床病理分期相同的残胃癌比近端胃癌预后较好,根治性切除术后残胃癌患者亦能达到较好的预后。

Objective： To explore the prognostic factors of remnant gastric cancer （RGC） and prognostic difference compared RGC with proximal stomach cancer with consistent TNM stage and treatment. Methods： The clinical data of 83 patients with RGC who underwent radical resection at the Cancer Institute and Hospital of Tianjin Medical University between July 1991 and July 2008 were analyzed. A paired case control study compared RGC with 83 proximal stomach cancers. Results： Tumor diameter, TNM stage, depth of invasion, and lymph node metastasis were important prognostic factors of RGC （ P 〈 0.05 ）, whereas TNM stage and depth of invasion were independent prognostic factors （ P 〈 0.05 ）. In the case control study, combined organ resection of RGCs were more frequent than proximal stomach cancers （ P = 0.022 ）. The survival rate and median survival for RGC were higher than those of proximal stomach cancer patients （ P = 0.042 ）. Conclusion： RGCs have better prognosis than proximal stomach cancer after radical resection.