高敏改良格拉斯哥预后评分与改良格拉斯哥预后评分对胃癌患者预后预测价值的比较

A contrastive analysis of high - sensitivity modified Glasgow prognostic score and modified Glasgow prognostic score on the prognostic predict of patients with gastric cancer

目的探讨高敏改良格拉斯哥预后评分（HS-mGPS）与改良格拉斯哥预后评分（mGPS）对胃癌患者预后预测价值的差异。 方法收集2005年1月至2009年12月于我科接受根治性手术治疗的552例胃癌患者的临床资料。按照HS-mGPS、mGPS相关评分标准分别对患者进行评分，比较不同评分水平患者肿瘤临床病理特征及预后的差异。 结果552例患者评分结果：mGPS 0分494例，mGPS 1分34例，mGPS 2分24例；HS-mGPS 0分411例，HS-mGPS 1分75例，HS-mGPS 2分66例，两种评分系统均与患者年龄、肿瘤TNM分期、区域淋巴结转移及血管侵犯存在相关性[mGPS（年龄：t＝10.292，P＝0.000;性别：χ2＝0.140，P＝0.942；肿瘤分化程度：χ2＝0.260，P＝0.883；TNM分期：χ2＝8.326, P＝0.000;淋巴结转移：χ2＝13.574，P＝0.000；血管侵犯：χ2＝13.501，P＝0.000）；HS-mGPS（年龄：t＝10.095，P＝0.002;性别：χ2＝1.195，P＝0.329；肿瘤分化程度：χ2＝0.512，P＝0.778；TNM分期：χ2＝7.060, P＝0.000；淋巴结转移：χ2＝13.468，P＝0.000；血管侵犯：χ2＝13.974，P＝0.000）]。患者术后死亡率影响的单因素及多因素分析结果显示，患者年龄、肿瘤分化程度、淋巴结转移、血管侵犯、肿瘤分期、HS-mGPS及mGPS评分均属于患者发生术后死亡的独立危险因素[单因素分析：性别：P＝0.187，比值比（OR）＝0.869;年龄：P＝0.000，OR＝1.474;肿瘤分化程度：P＝0.000，OR＝3.121;淋巴结转移：P＝0.000，OR＝4.059；血管侵犯：P＝0.000，OR＝3.535；TNM分期：P＝0.000，OR＝2.974; HS-mGPS：P＝0.000，OR＝4.578; mGPS：P＝0.000，OR＝2.331；多因素分析：年龄：P＝0.000，OR＝1.319;肿瘤分化程度：P＝0.107，OR＝1.235;淋巴结转移：P＝0.177，OR＝1.213;血管侵犯：P＝0.205，OR＝1.306；TNM分期：P＝0.000，OR＝2.909; HS-mGPS：P＝0.007，OR＝3.845; mGPS：P＝0.000，OR＝1.883]。 结论与mGPS评分系统比较，HS-mGPS评分系统降低了相关的评分标准，扩大了存在潜在不良预后风险的胃癌患者群体，对于改善该类患者的预后具有一定参考价值。

Objective To investigate the value difference of high- sensitivity modified glasgow prognostic score （HS -mGPS） and modified glasgow prognostic score （mGPS） on the prognostic predict of patients with gastric cancer. Methods The clinical data of 552 patients who were diagnosed with gastric cancer and accepted surgery treatment in our department were respectively collected. And all the patients were scored according to the score criterion of HS - mGPS and mGPS. Compare the difference of clinico- pathological characteristics of tumors and prognostic between patients with different scores. Results The score results for 552 patients are mGPS 0 score 494 cases, mGPS 1 score 34 cases, mGPS 2 score 24 ca- ses; HS-mGPS 0 score 411 cases, HS -mGPS 1 score 75 cases, HS -mGPS 2 score 66 eases, the 2 score systems are all correlate with patients＇ age, tumor TNM stage, local lymphatic metastasis and vascular invasion [ mGPS （ Age： t = 10. 292, P = 0. 000; Sex：χ2 = 0. 140, P = 0. 942; Tumor differentiation grade ： χ2 = 0. 260, P = 0. 883 ; TNM stage ：χ2 = 8. 326, P = 0. 000 ; Lymph node metastasis： χ2 = 13. 574, P=0.000; Venousinvasion＇ ＂ ：χ2=13.501, P=0.000） vs. HS-mGPS（Age：t=10.095, P=0.002; Sex：xz = 1. 195, P =0. 329; Tumor differentiation grade..）（2 =0. 512, P =0. 778; Lymph node metastasis： χ2 = 7. 060, P = 0. 000 ; Lymph node metastasis ：Xz = 13. 468, P = 0. 000; Venous invasion ：χ2 = 13. 974, P = 0. 000） ]. The resuhs of univariate and multivariate analysis of risk fators of death after surgery mani- fest that, age, tumor differentiation, tumor TNM stage, lymphatic metastasis, vascular invasion, mGPS and HS -mGPS are all independent risk factors of death after surgery [ Single factor analysis： Sex：P = 0. 187, odds ratio （OR） = 0. 869 ; Age ： P = 0. 000, OR = 1. 474 ; Tumor differentiation grade ： P = 0. 000, OR = 3. 121 ; Lymph node metastasis ： P = 0. 000, OR = 4. 059 ; Venous invasion ： P = 0. 000, OR = 3. 535 ; Tumor differentiation grade ： P = 0. 000, OR = 2. 974 ; HS - mGPS ： P = 0. 000, OR = 4. 578 ; mGPS ： P = 0. 000, OR = 2. 331 and Multiple factors analysis： Age： P = 0. 000, OR = 1. 319; Tumor differentiation grade ： P = 0. 010, OR = 1. 235 ; Lymph node metastasis ： P = 0. 017, OR = 1. 213 ; vascular invasion： P = 0. 020, OR = 1. 306 ; tumor TNM stage ： P = 0. 000, OR = 2. 909 ; HS - mGPS ： P = 0. 007, OR = 3. 845 ; mGPS： P =0. 000, OR = 1. 883 ]. Conclusion Compared with mGPS, the HS -mGPS download the score level, expanded the potential risk of poor prognosis of patients with gastric cancer, and may have a certain reference value in improve the prognosis of these patients.