改良Lauren分型评估胃癌预后价值研究(附2209例报告)

Modified Lauren classification in prognostic evaluation of gastric cancer:A report of 2209 patients

目的 探讨改良Lauren分型在评估胃癌预后中的价值,为胃癌术后的临床后续治疗及其化疗方案的选择提供参考。方法 回顾性分析2010年1月至2012年12月第二军医大学附属长海医院普外一科2209例术后证实为胃癌病人的临床资料,重新分析病理切片并结合肿瘤部位进行改良Lauren分型。2209例中,男1591例,女618例;平均年龄为（60.2±13.3）岁;平均随访时间为（36.1±2.1）个月。结果 Ⅰ型471例,Ⅱ型1047例,Ⅲ型691例;各组的存活率分别为68.8%,74.5%,57.5%,差异有统计学意义（χ2=77.9,P〈0.05）;T、N分期差异均有统计学意义（χ2=52.8,P〈0.05;χ2=89.7,P〈0.05）。Ⅱ型病人的预后明显优于Ⅰ型和Ⅲ型,差异有统计学意义（P〈0.05）。相关性分析显示,改良Lauren分型和胃癌的预后相关,回归系数为0.256,HR=1.291,95%CI 1.160~1.438,P〈0.05。改良Lauren分型、T分期、N分期均为胃癌病人生存的独立影响因素。结论 改良Lauren分型可作为胃癌的独立预后判定因素,并有助于为胃癌病人术后提供个体化治疗的参考意见。

Objective To investigate the clinical significance of modified Lauren classification in the prognostic evaluation of gastric cancer, and provide references of continuous treatment and chemotherapy regimens after operation. Methods The clinical data of 2209 gastric cancer patients with complete clinicopathological and follow-up data admitted from January 2010 to December 2012 in No.1 Department of General Surgery, Changhai Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. In 2209 patients, 1591 were male and 618 were female. The average age was 60.2±13.3 years old and the average follow-up was 36.1±2.1 months. Results According to modified Lauren classification, 471 patients were Classification I, 1047 patients were Classification II, and 691 patients were Classification III. The survival rate was 68.8%, 74.5%, 57.5% respectively, and among them the difference of survival rates and T, N stages was significant statistically （X2=77.9, P〈0.05; X2=52.8, P〈0.05;x2=89.7, P〈0.05）. The overall survival of Classification ]I was much better than Classification I and Classification m （P〈O.05）. At multivariate Cox proportional hazards model of OS analysis, modified Lauren classification was related to the prognosis of gastric cancer with regression coefficient：0.256, HR（95% CI）：1.291 （1.160-1.438, P〈0.05）. Modified Lauren classification and the T, N stages were independent prognostic factors for gastric cancer. Conclusion Modified Lauren classification of gastric cancer would be regarded as an independent prognostic factor and could help to provide references of postoperative individualized treatment for gastric cancer.