Ⅲ期胃癌患者的临床病理特征及预后分析

Clinicopathological characteristics and prognostic factors in patients with stage Ⅲ gastric cancer

目的 探讨Ⅲ期胃癌（按第7版TNM分期标准）的临床病理特征及影响预后的相关因素.方法 回顾性分析1991年1月至2005年12月间中国医科大学附属第一医院收治的经外科切除治疗的1007例Ⅲ期胃癌患者的临床病理和随访资料.分别采用Log-rank检验和Cox比例风险模型对Ⅲ期胃癌患者的预后进行单因素和多因素分析.结果 1007例Ⅲ期胃癌患者的平均年龄为58.7岁,男女比例为2.6∶1.0;ⅢA期242例,ⅢB期403例,ⅢC期362例.手术接受R0切除者754例（74.9％）,R1切除者56例（5.5％）,R2切除者197例（19.6％）；R0切除者5年生存率为37.8％,高于R１切除者（21.2％）和R2切除者（8.9％）,差异有统计学意义（P＜0.05）.多因素分析显示,pN分期、pT分期和Borrmann分型是影响R0切除患者预后的独立因素（均P＜0.01）.结论 Ⅲ期胃癌患者有其自身的临床病理学特点,治疗上应尽可能施行R0根治术.淋巴结转移数目、肿瘤浸润深度和Borrmann分型是影响接受R0手术的Ⅲ期胃癌患者预后的重要因素.

Objective To investigate the clinicopathological characteristics and prognositic factors of stage Ⅲ gastric cancer.Methods A retrospectively study of 1007 patients with Stage Ⅲ gastric cancer in a single institute in China was performed.The patients underwent surgical resection from January 1991 to December 2005.Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model to access the prognostic factors in stage Ⅲ gastric cancer patients who received curative （RO） gastric resection.Results The mean age of the 1007 patients was 58.7 years and the male-to-female ratio was 2.6∶1.0.There were 242 patients with stage Ⅲ A disease,403 patients with stage Ⅲ B,and 362 patients with stage Ⅲ C.R0,R1,and R2 resection were performed in 754 patients （74.9%）,56 patients （5.5%）,and 197 patients （19.6%）,respectively.The 5-year survival rate （37.8%） of patients who received R0 resection was significant higher than that of patients who received R1 （21.2%） and R2（8.9%） resection （P〈0.05）.Multivariate analysis revealed that pN stage,pT stage,and Borrmann type were independent prognostic factors （all P〈0.01 ）.Conclusions Stage Ⅲ gastric cancer patients have certain clinicopathological characteristics and R0 resection should be performed if possible.Lymph node count,depth of tumor invasion,and Borrmann type are independent prognostic factors in stage Ⅲ gastric cancer patients undergoing R0 resection.