胃癌术后放化疗后失败模式分析

Patterns Analysis of Failure in Gastric Cancer After Surgery and Chemoradiotherapy

目的:探讨胃癌根治术后放化疗后肿瘤局部复发及远处转移模式及预后因素。方法:回顾性分析2004-2014年143例胃癌根治术后在我院行化疗及序贯放化疗后复发转移患者,对其首次失败部位、预后影响因素进行分析。结果:143例术后失败中局部复发93例,最常见部位分别为腹膜后淋巴结、瘤床、吻合口,其中腹膜后淋巴结转移多为第16组淋巴结A2、B1站,远处转移共89例,以腹腔种植、肝脏、肺较常见。术后放疗组中局部复发概率明显小于术后化疗组,远处转移概率无明显区别。单因素分析显示肿瘤TNM分期、分化程度、手术方式、淋巴结阳性率、浸润深度为影响胃癌术后无进展生存期的因素(P<0.05)。结论:胃癌术后患者应强调规范化的综合治疗以减少复发及转移,其失败模式主要以腹膜后淋巴结转移及腹腔种植转移为主,辅助性放疗可明显减少局部复发概率。

Objective. To evaluate the patterns of failure in gastric cancer and investigate the recurrence risk factors. Methods. A retrospective analysis of 143 cases with recurrent gastric cancer after op- eration and chemoradiotherapy in Zhongnan Hospital of Wuhan University during 2004-2014 on the first relapse site, time to recurrence as well as other prognostic factors were analyzed. Results. Of 143 patients, locoregional recurrence was observed in 80 patients and distant metasta- sis in 79 patients. Intra-abdominal lymph nodes, gastric stump, and anastomosis, were the most common sites of locoregional recurrence, while in the intra-abdominal lymph nodes, the 16th group A2, B1 site were the most common. Enterocoelia, liver and lung were the most frequent sites of distant metastasis. Postoperative local recurrence probability of radiotherapy group was obviously less than that of postoperative chemotherapy group, but there was no obvious differ- ence in the probability of distant metastasis. Univariate survival analysis showed that the tumor TNM stage, invasive depth, lymph node metastasis were related to recurrence in gastric cancer （P〈0.05）. Conclusion. Intra-abdominal lymph nodes recurrence and peritoneal implantation were the predominant patterns in patients after treatment in gastric cancer patients. The strategy of treatment for gastric cancer was comprehensive treatment to reduce relapse.