粤北地区贲门癌患者幽门螺杆菌感染与预后的相关性研究

Correlation between Helicobacter pylori infection and prognosis of cardia cancer patients in northern Guangdong

目的探讨粤北地区贲门癌人群的幽门螺杆菌感染与临床病理特征和患者预后的关系。方法收集2010年1月至2014年12月在粤北人民医院手术并经病理确诊的贲门癌患者手术标本70例,每例均有完整随访资料;采用改良Giemsa染色法原位检测贲门癌组织、癌旁组织及切缘组织中幽门螺杆菌感染情况,采用SPSS19.0软件统计分析其与临床病理特征及患者预后的关系。结果 70例贲门癌患者中幽门螺杆菌感染阳性42例,感染率为60.0%;有抗幽门螺杆菌治疗史的患者感染率为33.3%,明显低于无抗幽门螺杆菌治疗史患者的69.2%,差异有统计学意义(P<0.05);幽门螺杆菌感染率与贲门癌患者的年龄分组、性别、肿瘤分化、淋巴结转移及病理分期不相关(P>0.05);70例贲门癌患者中位生存时间为40.4个月,幽门螺杆菌感染阴性、年龄60岁以下、淋巴结无转移和术后化疗的患者平均生存期分别为51.2个月、50.8个月、61.2个月、52.2个月,较幽门螺杆菌感染阳性、年龄60岁以上、淋巴结转移、术后无化疗组患者平均生存期延长,差异均具有统计学意义(P<0.05);Cox回归模型显示,幽门螺杆菌感染不是影响贲门癌患者预后的独立因素(P>0.05),而淋巴结转移和术后化疗是影响贲门癌患者生存率的独立预后因素(P<0.05)。结论幽门螺杆菌感染在一定程度上影响粤北地区贲门癌的发生发展及预后,但并非贲门癌的独立预后因素。

Objective To investigate the correlation of Helicobacter pylori （HP） infection with clinicopathological features and prognosis of cardia cancer patients in northern Guangdong. Methods A total of 70 surgical specimens of cardiac cancer patients who underwent surgery and pathologic diagnosis in Yuebei People＇s Hospital during Jan. 2010 and Dec. 2014 were investigated. Complete follow-up data were available in each case. Giemsa stain is used to observe H. pylori in infected gastric cardia carcinoma tissue, cancer-adjacent tissue and incisal margin tissue. The correlation of HP infection with clinicopathological features and prognosis of cardia cancer patients were analyzed by SPSS19.0 software. Results Of the 70 cardia cancer patients, 42 （60.0%） exhibited HP infection. The infection rate in patients who have previously been treated for HP infection was lower than in those without HP disease （33.3% vs 69.2%, P〈0.05）. No statistically significant association was observed between HP infection rate and patients＇ age, gender, tumor differentiation, lymph node metastasis or clinical stage （P〉0.05）. The median survival time of 70 patients with cardia cancer was 40.4 months. The mean survival times of patients without HP negative infection, under 60 years of age, without lymph node metastasis and treated with chemotherapy were 51.2 months, 50.8 months, 61.2 months and 52.2 months, respectively, which were longer than the survival times of those with HP infection, over 60 years of age, with lymph node metastasis and without postoperative chemotherapy （P〈0.05）. The Cox＇s regression model showed that HP infection was not an independent prognostic factor for cardia cancer （P〉0.05）, but lymph mode metastasis and postoperative chemotherapy were associated independently with prognosis of cardia cancer patients （P〈0.05）. Conclusion To some extent, HP infection affects the occurrence, development and prognosis of cardia cancer in northern Guangdong, but is not an in- dependent prognostic factor for cardiac cancer.