胃癌合并穿孔患者术后生存影响因素的临床分析

Clinical analysis of prognostic factors of patients with perforated gastric cancers

目的调查胃癌合并穿孔患者术后的生存情况,并研究其影响因素。方法采用Cox模型回顾性分析2000年1月至2011年7月收治的61例胃癌穿孔手术病例的临床资料。结果患者术后中位生存时间120d,1、3、5年生存率分别是31.1%(19/61)、3.3%(2/61)和0(0/61)。多因素Cox回归分析结果表明,与Ⅱ期胃癌比,Ⅲ期(OR=4.875,P=0.040)和Ⅳ期(OR=9.386,P=0.006)胃癌穿孔患者的预后差。与一期根治术相比,行单纯修补术和姑息性胃切除术的OR值分别是3.937和2.347(P<0.05)。此外,患有并存病也是预后的危险因素(OR=4.337,P=0.002)。结论胃癌穿孔患者术后生存期较短,且受胃癌TNM分期、手术方式及是否有并存病的影响。建议在患者全身状况许可情况下行一期胃癌根治术。对于癌肿广泛转移而无法切除者,姑息性胃切除在该病治疗中仍发挥重要作用。

Objective To clarify the postoperative survival of patients with perforated gastric cancers and to investigate the prognostic factors. Methods Clinical data of 61 patients with perforated gastric cancers who underwent emergent surgical treatments from January 2000 to July 2011 were analyzed retrospectively by the Cox proportional hazards model. Results The median of postoperative survival was 120 days, and 1-, 3- and 5-year-survival rates were 31.1% （19/61）, 3.3% （2/61） and 0（0/61） respectively. Multivariant Cox analysis showed that staging was the most significant prognostic factor for perforated gastric cancer. Compared to Stage Ⅱ, the prognosis of stage Ⅲ （OR=4.875, P=0.040） and stage Ⅳ （OR=9.386, P=0.006） was worse. Compared to radical gastrectomy, the OR of prime repair and palliative surgery were 3.937 and 2.347 respectively （P0.05）. Furthermore, co-morbidity was also a predictor （OR=4.337, P=0.002）. Conclusions Patients with perforated gastric cancers have a poor survival rate, and both staging and surgical options are the significant prognostic factors. Prime radical gastrectomy can be performed under appropriate conditions; but if there is a non-resectable tumor, palliative gastrectomy is also indicated.