胃癌根治术中切缘肿瘤残留危险因素的分析

Study of the risk factors of resection-margin involvement in radical gastrectomy of gastric cancer patients

目的:明确胃癌根治术(D2)中切缘(resection margins,RM)肿瘤残留(R1)发生的独立危险因素。方法:回顾性分析2008年1月至2009年11月长海医院普通外科收治的412例行胃癌根治术患者资料。对影响上切缘(proximal resection margins,PRM)/下切缘(distal resection margins,DRM)R1发生的相关因素进行单因素分析及Logistic多因素回归分析。利用ROC曲线评估PRM/DRM距离预测PRM/DRM R0的价值。结果:单因素分析显示,影响PRM R1发生的因素包括肿瘤大小、肿瘤部位、Borrmann分型、血清肿瘤标志物、手术方式、PRM距离、T分期、N分期及TNM分期(均P<0.05);影响DRM R1发生的因素包括DRM距离、T分期及肿瘤浸润血管(均P<0.05)。多因素分析显示,N3(RR=2.677)和PRM距离(RR=0.423)是PRM R1发生的危险因素;DRM距离(RR=0.407)是DRM R1发生的危险因素。PRM距离用于预测PRM R0最佳界值为2.05cm(敏感性为79.9%,特异性为75.0%)。DRM距离用于预测DRM R0最佳界值为1.65cm(敏感性为88.6%,特异性为66.7%)。结论:N3期和PRM距离是PRM R1发生的独立危险因素,DRM距离是DRM R1发生的唯一独立危险因素。PRM/DRM距离最佳界值可用于指导实现RM R0。

Objective： To investigate the risk factors of resection-margin（RM）involvement（R1）in radical gastrectomy of gastric cancer patients.Methods：The clinical data of 412 cases of radical gastrectomy performed from January2008 to November 2009 in Changhai Hospital were analyzed retrospectively.The potential risk factors of proximal resection margins（PRM）/distal resection margins（DRM）R1were analyzed by univariate and multivariate Logistic regression analysis.Assess the value of PRM/DRM distance in the anticipating of PRM/DRM R0.Results：The univariate analysis showed that the risk factors of PRM R1 included tumor size,tumor location,Borrmann type,tumor marker in serum,operation method,PRM distance,T stage,N stage and TNM stage（all P〈0.05）,and the risk factors of DRM R1 included DRM distance,T stage and vascular invasion（all P〈0.05）.The multivariate Logistic regression analysis showed that the risk factors of PRM R1 included N3（RR=2.677）and PRM distance（RR=0.423）,and the risk factors of DRM R1 was DRM distance（RR=0.407）.The best cutoff value point of PRM distance in the anticipating of PRM R0 was 2.05cm（sensitivity 79.9%and specificity 75.0%）,the best cutoff value point of DRM distance in the anticipating of DRM R0 was 1.65cm（sensitivity 88.6% and specificity66.7%）.Conclusions：N3stage and PRM distance are independent risk factors of the incidence of PRM R1 and DRM distance is the only independent risk factors of the incidence of DRM R1.The best cutoff value point of PRM/DRM distance can be used to help the surgeons obtain PRM R0.