不同病理类型进展期胃癌的预后因素分析

Prognostic factors of different pathological types of advanced gastric cancer

目的探讨不同病理类型进展期胃癌患者的临床病理特征及预后因素。方法回顾性分析2011年间在南京大学医学院附属鼓楼医院集团宿迁市人民医院行胃癌根治术的98例进展期胃癌患者的临床病理资料,其中胃腺癌53例,胃黏液腺癌30例,胃印戒细胞癌15例,比较不同病理类型进展期胃癌患者的临床病理特征及预后的差异。结果 (1)3种不同病理类型进展期胃癌患者的性别、年龄、神经侵犯及分化程度比较差异无统计学意义(P>0.05),而其肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、淋巴管癌栓、侵犯深度及p TNM分期比较差异有统计学意义(P<0.05)。(2)单因素分析结果显示,胃腺癌患者的预后与肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、侵犯深度及p TNM分期有关(P<0.05),胃黏液腺癌患者的预后与手术根治类型、区域淋巴结转移及p TNM分期有关(P<0.05),胃印戒细胞癌患者的预后与区域淋巴结转移、侵犯深度及p TNM分期有关(P<0.05)。(3)将与3种不同病理类型进展期胃癌患者预后有关的因素进一步行Cox多因素分析,结果显示,肿瘤位置(P=0.016)、区域淋巴结转移(P=0.042)、侵犯深度(P=0.021)及p TNM分期(P=0.009)是影响胃腺癌患者预后的独立危险因素,区域淋巴结转移是影响胃黏液腺癌患者预后的独立危险因素(P=0.000),肿瘤侵犯深度(P=0.032)及区域淋巴结转移(P=0.002)是影响胃印戒细胞癌患者预后的独立危险因素。(4)随访时间60个月,胃腺癌患者的中位随访时间为32个月,胃黏液腺癌患者为43个月,胃印戒细胞癌患者为23个月,5年累积生存率胃腺癌患者为30.2%,胃黏液腺癌患者为23.3%,胃印戒细胞癌患者为26.7%。三者生存曲线比较差异无统计学(P=0.131)。结论不同病理类型进展期胃癌患者的临床病理特征有一定的差异,从而影响其预后的因素也不同,但是区域淋巴结转移是影响3种不同病理类型进展期胃癌患者的共同预后因素。

Objective To explore clinicopathologic features and prognostic factors of different pathological types of advanced gastric cancer. Methods The clinicopathologic data of 98 patients with advanced gastric cancer who underwent radical gastrectomy in Suqian People＇s Hospital, Nanjing Drum Tower Hospital Group, Affiliated to Nanjing University Medical School in 2011 were analyzed retrospectively. There were 53 cases of gastric adenocar- cinoma, 30 cases of mucinous adenocarcinoma, and 15 cases of signet ring cell carcinoma among them. The differences of clinicopathologic characteristics and prognosis were compared among different pathological types of advanced gastric cancer. Results ① There were no significant differences in terms of the gender, age, nerve invasion, and degree of differentiation among the three groups （P〉0.05）, there were significant differences in terms of the tumor diameter, tumor location, radical surgery type, regional lymph node metastasis, lymphatic cancer embolus, depth of invasion, and pTNM stage among the three groups （P〈0.05）. ② The results of the univariate analysis showed that the prognosis of gastric adenocarcinoma was associated with the tumor diameter, tumor location, radical surgery type, regional lymphnode metastasis, depth of invasion, or pTNM stage （P〈0.05）; the prognosis of mucinous adenocarcinoma was associated with the radical surgery type, regional lymph node metastasis, or pTNM stage （P〈0.05）; the prognosis of signet ring cell carcinoma was associated with the regional lymph node metastasis, depth of invasion, and pTNM stage （P〈0.05）. ③ The results of the Cox multivariate analysis showed that the tumor location （P=0.016）, regional lymph node metastasis （P=0.042）, invasion depth （P=0.021）, and pTNM stage （P=0.009） were the independent risk factors of prognosis for the gastric adenocarcinoma; the regional lymph node metastasis was the independent risk factor of prognosis for gastric mucinous adenocarcinoma （P=0.000）; the tumor invasion depth （P=0.032） and regional lymph node metastasis （P=0.002） were the independent risk factors of prognosis for signet ring cell carcinoma. ④ The follow-up time was 60 months. The median follow-up time was 32 months in the gastric adenocarcinoma, 43 months in the mucinous adenocarcinoma, 23 months in the signet ring cell carcinoma, the 5-year accumulated survival rate was 30.2%, 23.3%, and 26.7% respectively. The comparison of survival curves of these three different pathological types of gastric cancer had no significant difference （P=0.131）. Conclusion Clinical and pathological features of patients with different pathological types of advance gastric cancer present some differences, and prognostic factors are also different, but regional lymph node metastasis is a common prognostic factor for different pathological types of advanced gastric cancer.