不同部位进展期胃癌的临床病理特征及预后分析

Analysis of clinicopathoiogical features and prognosis in patients with advanced gastric cancer in different locations

目的探讨不同部位进展期胃癌临床病理特征及预后，为进一步合理选择诊疗方案提供线索。方法回顾性分析2011年1一12月在哈尔滨医科大学附属肿瘤医院行胃癌根治术的421例进展期胃癌患者的临床病理资料，其中胃上部癌48例，中部癌74例，下部癌299例，分别比较不同部位胃癌临床病理特征及预后的差异。结果3组不同部位进展期胃癌患者的病灶大小（P=0．001）、大体类型（P=0．033）、浸润深度（P=0．010）、淋巴结转移（P=0．000）和病理分期（P=0．019）差异均有统计学意义；而胃上部癌5am以上病灶以及T4、N3和Ⅲ期患者比例大于胃中部和胃下部癌患者（均P〈0．05）。生存分析显示，胃上、中、下部癌患者术后3年生存率分别为27．1％、37．8％和44．8％，差异有统计学意义（P〈0．05）。多因素预后分析结果显示，浸润深度（P=0．034，HR=1．918）是进展期胃上部癌的独立预后因素；淋巴结转移（P=0．022，HR=1．406）是进展期胃中部癌的独立预后因素；浸润深度（P=0．022，HR=I．359）和淋巴结转移（P=0．000，HR=1．519）是进展期胃下部癌的独立预后因素。结论与进展期胃中、下部癌相比，进展期胃上部癌病灶大，浸润程度深，淋巴结易转移，TNM病理分期偏晚，预后较差。

Objective To investigate the differences of clinicopathological features and prognosis in patients with advanced gastric cancer in different locations after radical gastrectomy, and to provide optimized therapies. Methods Clinicopathological data of 421 patients with advanced gastric cancer undergoing radical gastrectomy in our department from January to December 2011 were analyzed retrospectively. Patients were divided into 3 groups according to cancer locations, including 48 cases of upper gastric cancer, 74 cases of middle gastric cancer and 299 cases of lower gastric cancer. Clinicopathological features and prognosis were compared among groups. Results There were significant differences among 3 groups in lesion size（P=0.001）, subtypes（P=0.033）, pT classification（P=0.010）, TNM staging（P=0.019） and lymph node metastasis （P=0.000）. Ratio of lesion size 〉5 cm, and T4, N3, stage m patients was significantly higher in upper gastric cancer group as compared to middle and lower group （all P〈0.05）. The survival curves showed that the general prognosis of upper gastric cancer group was worse than that of middle and lower gastric cancer group （P〈0.05）, while no significant difference was found between middle and lower gastric cancer group （P=0.027）. Multivariate analysis revealed that depth of invasion （P=0.034, HR=1.918） was independent prognostic factor of advanced upper gastric cancer, lymph node metastasis （P=0.022, HR=1.406） was independent prognostic factor of advanced middle gastric cancer, and depth of invasion （P=0.022, HR=1.359） and lymph node metastasis （P=0.000, HR=1.519） were independent prognostic factors of advanced lower gastric cancer. Conclusion As compared to advanced middle and lower gastric cancer, advanced upper gastric cancer possesses bigger cancer lesion, deeper depth of invasion, easier metastasis of lymph nodes, later TNM staging, and worse prognosis.