影响进展期胃癌预后的多因素分析

Multivariate analysis of prognosis in patients with advanced gastric cancer

目的探讨包括临床病理特征、肿瘤标志物水平、炎性指标在内的23项指标对判断进展期胃癌预后的价值。方法回顾性分析我院248例Ⅲ～Ⅳ期胃癌术后患者的病例资料。采用Kaplan-Meier法计算生存率,用Log-rank法进行单因素分析,Cox风险比例模型进行多因素分析。结果单因素分析显示肿瘤大小、T分期、N分期、Lauren分型、脉管浸润、手术方式、癌胚抗原(CEA)、糖类抗原(CA)724、CA199、CA125、Glasgow预后评分(GPS)、中性粒细胞淋巴细胞比率(NLR)、血小板淋巴细胞比率(PLR)与进展期胃癌预后有关。多因素分析显示姑息性手术、T4b、CEA升高、CA199升高是判断进展期胃癌预后的独立危险因素。结论姑息性手术、T4b、CEA升高、CA199升高是影响进展期胃癌术后患者预后的独立危险因素。

Objective To investigate the value of clinicopathologic characteristics,serum tumor markers and inflammatory factors in judging the prognosis of advanced gastric cancer. Methods Two hundred and forty-eight gastric cancer patients with stageⅢ-Ⅳ undergoing operation in Nanjing Drum Hospital between 2008 and 2013 were included in this study. The postoperative survival rate was calculated by Kaplan-Meier method. Univariate analysis of prognosis were used by Log-rank method. Multivariable analysis of prognosis was used by Cox proportional hazad regression model. Results In univariate analysis,tumor size,T staging,N staging,Lauren classification,vascular invasion,surgical modalities,carcinoembryonic antigen（ CEA）,carbohydrate antigen（ CA） 724,CA199,CA125,Glasgow prognostic score（ GPS）,neutrophil to lymphocyte ratio（ NLR） and platelet to lymphocyte ratio（ PLR） were associated with overall survival in patients with advanced gastric cancer. Multivariate analysis revealed that palliative surgery,stage of T4b,CEA,CA199 were independent risk factors of poor prognosis. Conclusion Palliative surgery,stage of T4b,CEA,CA199 are independent risk factors of patients with advanced gastric cancer.