肿瘤最大径对T4a期胃癌患者预后的影响

The prognostic analysis of tumor size in T4a stage gastric cancer

目的评价肿瘤最大径对T4a期胃癌患者预后的影响。方法Kaplan—Meier生存分析筛选T4a期胃癌肿瘤最大径的最佳截点值，并据此将患者分为2组。比较2组患者的临床病理因素，对T4a期胃癌进行单因素和多因素分析，并对预后独立影响因素进行分层分析。结果T4a期胃癌肿瘤最大径最佳截点值为8ClTI。2组患者的肿瘤部位（x2=15．695）、分化类型（X2=4．393）、大体形态（x2=5．629）和早期复发（x2=4．292）差异有统计学意义（P〈0．05）。单因素分析显示年龄（x2=4．463）、肿瘤最大径（x2=9．057）、Borrmann分型（）（2=6．679），分化类型（x2=5．122）、肿瘤部位（x2=8．707）和N分期（x2=132．954）与T4a期胃癌预后相关（P〈0．05）；多因素分析显示肿瘤最大径（HR=1．339），分化类型（HR=1_169）和N分期（HR=1．876）为T4a期胃癌预后独立影响因素（P〈0．05）。进一步按肿瘤最大径分层分析，N分期（HR=2．014）和分化类型（HR=1．192）是最大径〈8cm组T4a期胃癌预后独立影响因素（P〈0．05），N分期（HR=1．876）是最大径≥8cm组T4a期胃癌预后的独立影响因素（P=0．000）。预后独立影响因素分层分析显示，无淋巴结转移或低分化的T4a期胃癌，≥8cnl组的5年生存率明显低于〈8cm组（HR=0．182、0．653，P〈0．01）。结论肿瘤大小截点值为8Cm时，肿瘤最大径是影响T4a期胃癌预后的独立影响因素，可显著影响无淋巴结转移或低分化胃癌患者的预后。

Objective To investigate the impact of tumor size in the prognosis of T4a stage gastric cancer. Methods The best cut-off point depending on tumor size was selected by Kaplan-Meier. Compare elinicl6pathological characteristics between small size gastric cancer （SSG） and large size gastric cancer （LSG）. Univariate analysis was done by Log-rank test and multivariate analysis was performed using the Cox proportional hazard regression model. The independent prognostic factors of patients were performed subgroup analysis. Results Eight eentimetre was the optimal cut-off of tumor size for T4a stage gastric cancer. There were significantly differences between SSG and LSG in tumor location （ X2 = 15. 695 ）, histological grade （X2 = 4. 393）, macroscopic type （X2 = 5. 629） and early recurrence （X2 = 4. 292 ）. Univariate analysis showed age （ X2 = 4. 463 ）, tumor size （ X2= 9. 057 ）, macroscopic type （ X2 = 6. 679 ）, histological grade （X2= 5. 122）, location of tumor （X2 = 8. 707） and N stage （X2 = 132. 954） are related to survival （P〈0. 05）. Among them, tumor size （HR = 1. 339）, histological grade （HR = 1. 169） and N stage （HR = 1. 876） were independent risk factor for survival （P =0.05）. For SSG, N stage （HR =2. 014） and histological grade （HR = 1. 192） were independent risk factor for survival （P = 0. 05 ） , and for LSG, N stage （HR= 1. 876 ） was independent risk factor for survival （P = 0. 000 ）. Further stratified analysis indicated that the 5-year survival rate of LSG is significantly lower than that of SSG in T4a stage patients of gastric cancer without lymph nodes metastasis or poorly differentiated （HR = 0. 182 and O. 653, P 〈 0. 01 ）. Conclusions Tumor size is an independent prognostic factor in patients of T4a stage gastric cancer. Tumor size cut-off point of 8 cm can exert significant impact on the prognosis of T4a stage gastric cancer without lymph nodes metastasis or poorly differentiated.