合并胃周软组织转移胃癌的临床病理特征及预后

Clinicopathology and prognosis of gastric cancer patients with perigastric soft tissue involvement

目的分析合并胃周软组织转移胃癌的临床病理特征及其对预后的影响。方法接受根治性手术的胃癌患者共1025例，依胃周软组织转移情况分为转移组（334例）、非转移组（691例），比较两组的临床病理参数及预后。结果非转移组的近端、中部、远端为主的胃癌及全胃癌分别占25．8％、22．0％、51．4％和0．9％，转移组分别占33．2％、21．3％、41．3％和4．2％，转移组的近端为主癌及全胃癌的比例显著升高（P=0．000）；转移组肿瘤直径≥5cm者占47．3％，显著高于非转移组的27．0％（P=0．000）；转移组浸润深度达T4者占40．7％，显著高于非转移组的10．3％（P=0．000）；转移组淋巴结转移度在21％～40％及41％-100％者分别占24．4％、37．3％，非转移组分别为12．9％、10．8％，差异有统计学意义（P=0．000）；转移组远处转移者占20．1％，显著高于非转移组的4．1％（P=0．000）；转移组Borrmann浸润型者占82．1％，显著高于非转移组的64．6％（P=0．000）；转移组肿瘤低分化或未分化癌占78．7％，显著高于非转移组的64．2％（P=0．000）；转移组血清CEA阳性者占21．2％，显著高于非转移组的11．4％（P=0．000）。COX回归分析表明浸润深度、脏器侵犯、淋巴结转移度、M分期、Borrmann分型、胃周软组织转移结节为胃癌的独立预后因素。转移组较非转移组预后不良（P=0．000）。分层分析表明，无论肿瘤大小、浸润深度、淋巴结转移度、血清CEA值、Borrmann分型、分化程度如何，转移组的预后均不良（P〈0．01）。无远处转移时，转移组预后不良（P=0．000）；合并转移时，两组中位生存期相比差异无统计学意义（P=0．076）。结论胃周软组织转移是胃癌进展中的常见事件，多发生在肿瘤直径≥5cm、邻近脏器浸润、淋巴结转移度≥21％、合并远处转移、Borrmann浸润型、低或未分化癌、血清CEA阳性患者。胃周软组织转移为胃癌的独立预后因素。

Objective To analyze the clinicopathological features and prognosis of gastric cancer patients with metastatic nodules of perigastric soft tissue. Methods In this study, 1025 cases of gastric cancer received radical resection. According to the metastasis of perigastric soft tissue, patients were divided into metastatic group （ group MP, n = 334 ）, non-metastatic group （ group NMP, n = 691 ）. The clinicopathological features and prognosis were compared between the two groups. Results In group MP, the ratio of upper, middle, lower, total gastric cancer was 25. 8% , 22.0% , 51.4%, 0. 9% and the ratio in group NMP was 33.2%, 21.3%, 41.3%, 4.2% respectively, showing significant higher ratio of upper and total gastric cancer in MP group （ P = 0. 000 ）. In group MP 47. 3% cases with tumor size ≥ 5 cm, significantly higher than that in NMP group （ 27% ） （P = 0. 000）. Lymph node metastatic ratio between 21% -40% and 41% - 100% was found in 24.4% and 37. 3% in MP group respectively, significantly higher than that of 12. 9%, 10. 8% in NMP group（P =0. 000）. 20. 1% cases had distal metastasis in group MP, significantly higher than that of 4. 1% in group NMP（P =0. 000）. In group MP and NMP group, the ratio of Borrmann infiltration typing was 82. 1% vs. 64. 6%, the ratio of positive CEA was 21.2% vs. 11.4%, the ratio of lower or undifferentiation typing was 78.7% vs. 64. 2%, all with significant difference （P = 0. 000 ）. COX regression analysis showed the infiltration depth, organic invasion, lymph node metastatic ratio, M staging, Borrmann typing, metastatic nodules was the independent prognostic factors. Prognosis was significantly poorer in the cases with perigastric soft tissues than without （ P =0. 000 ）. Stratified analysis showed that irrespective of tumor size, infiltration depth, lymph node metastatic ratio, CEA value, Borrmann typing, differentiation degree, the mean survival time was significantly shorter in MP group than that in group NMP（P 〈0. 005）. In cases without distal metastasis, the prognosis was significant poorer in group MP than that in group NMP （ P = 0. 000）, however, there was no significant difference between two groups in cases without distal metastasis （ P = 0. 076）. Conclusions Perigastric soft tissue metastasis was common in gastric cancer, more frequently seen in tumor ~ 5 cm, or with organic invasion, lymph node metastatic ration ≥ 21%, distal metastasis, Borrmann infiltration typing, lower or undifferentiation typing, positive CEA. Perigastric soft tissues metastasis was the independent prognotic factor for gastric cancer.