基于COX回归研究Borrmann Ⅳ型胃癌的预后因素

Study of prognostic factors in Borrmann type Ⅳ gastric cancer based on COX regression

目的探讨影响BorrmannⅣ型胃癌预后的相关因素,寻找改善其预后的方法。方法回顾性分析2000年1月至2010年12月中山大学肿瘤防治中心收治的有完整随访资料的BorrmannⅣ型胃癌220例。选择年龄(X_1)、性别(X_2)、腹水(X_3)、肿瘤波及范围(X_4)、肿瘤大小(X_5)、手术方式(X_6)、分化程度(X_7)、术后病理分期(pTNM)(X_8)、综合治疗(X_9)共9项临床病理参数作为观察指标。Kaplan-Meier法计算中位生存时间和生存率,影响生存率的单因素分析用Log-rank检验,Cox回归风险比例模型行多因素预后分析。结果生存分析显示,全组患者的中位生存期288 d,1、3、5年生存率分别为47.1%、14.3%、9.1%。单因素分析表明,年龄、有无腹水、肿瘤波及范围、肿瘤大小、手术方式、p TNM分期均为BorrmannⅣ型胃癌预后的影响因素,COX回归多因素分析发现,手术方式、p TNM分期是影响BorrmannⅣ型胃癌预后的独立因素(P<0.05)。结论提高BorrmannⅣ型胃癌的早期诊断水平及手术切除率有利于改善预后。

Objective To investigate the related prognostic factors of Borrmann type Ⅳ gastric cancer and to find out ways of improving survival rate.Methods The clinical data of two hundred and twenty patients with Borrmann type IV gastric cancer at Cancer Center of Sun Yat-sen University from January 2000 to December 2010 were reviewed.In total nine clinicopathologic variables such as age,sex,ascites,tumor extent,tumor size,operation type,pathological pattern,pTNM stage and comprehensive therapy were selected as observation indexes.The median survival and survival rate were estimated by the Kaplan-Meier survival curve and the log-rank test.Multivariate COX＇s proportional hazards regression analysis was then performed to distinguish the independent prognostic factors.Results The median survival time was 288 days and 1-,3-,5-year survival rate was 47.1%,14.3%,9.1%,respectively.Univariate analyses showed that age,ascites,tumor extent,tumor size,operation type and pTNM stage significantly influenced survival.Operation type and pTNM stage were regraded as the statistically significant independent risk factors associated with the prognosis of Borrmann type Ⅳ gastric cancer using Cox model（P〈0.05）.Conclusion Improving the prognosis for patients with Borrmann type Ⅳ gastric carcinoma requires early diagnosis and curative resection.