Ⅲ期和Ⅳ期胃癌根治术后早期复发的危险因素分析

Analysis of risk factors of early recurrence in patients with gastric cancer in stage Ⅲ or Ⅳ after radical resection

目的:寻找影响Ⅲ、Ⅳ期胃癌早期复发的危险因素。方法:以126例Ⅲ、Ⅳ期胃癌根治术后复发患者为研究对象,查阅病历获得临床和病理资料。比较早期复发组和晚期复发组的临床病理特点,应用Logistic多元回归分析早期复发的危险因素。结果:早期复发者93例,占73.8%;晚期复发者33例,占26.2%。早期复发组的淋巴结切除数目明显少于晚期复发组(P<0.05),而Bormann分型属于Ⅲ、Ⅳ型,具有神经旁浸润和血管浸润的病例较晚期复发组更为多见(P<0.05)。Logistic多元回归分析发现神经旁浸润为早期复发的独立危险因素。结论:Ⅲ、Ⅳ期胃癌患者行胃癌根治术后多在2年内复发,术后2年应是重点随访阶段。常规病理报告中列出神经旁浸润对于判断预后、制定随访方案具有重要的临床意义。

Objective： To find the risk factors which influence the early recurrence in patients with gastric cancer in stage Ⅲ or Ⅳ. Methods： 126 Ⅲ or Ⅳ patients with recurrent gastric cancer were included. Clinicopathologic information were retrospective analyzed by medical record. Clinicopathologic characteristics were compared between the early recurrence group and the late recurrence group. Multivariate logistic regression analysis was used to estimate the strength of association between early recurrence and various factors. Results： The number of patients who recurred within 2 year was 93 patients, which was 73.8% of all the patients. The number of patients who recurred after 2 years was 33 patients, and they accounted for 26.2% of all the patients. The number of dissected lymph node in the early recurrence group was less than that in the late recurrence group（P〈0,05）. The cases with Ⅲ or Ⅳ type according to Bormann type, vascular infiltration or perineural invasion were significantly more prevalent in the early recurrence group than in the late recurrence group（P〈0.05）. Logistic regression analysis revealed that perineural invasion was independent risk factor for early recurrence. Conclusion： Most recurrent gastric cancer occurs within 2 years after radical redection in stage Ⅲ or Ⅳ gastric cancer patients. The focus of follow-up phase is 2 years from surgery. Perineural invasion should be listed in routine pathology report, which have important clinical significance in judgement of prognosis and the development of follow-up programs.