临床病理因素评分对T_2N_0M_0期胃癌预后的评估价值

Evaluation value of clinical pathological factors score on prognosis of T_2N_0M_0 gastric cancer

目的探讨影响T_2N_0M_0期胃癌预后的独立因素,建立临床病理因素评分,预测T_2N_0M_0期胃癌患者预后。方法收集2006-2013年收治的经根治性手术切除的T_2N_0M_0期且随访资料完整的215例胃癌患者的临床资料进行回顾性分析,应用Kaplan-Meier法计算生存率,采用Log-rank法行生存率比较,采用Cox模型做多因素分析,找出独立的预后影响因素。建立T_2N_0M_0期胃癌患者的临床病理因素评分,根据评分结果判断该病理分期患者的预后。结果患者的5、10年总生存率分别为90.69%、87.40%。单因素分析结果显示,肿瘤直径≥3cm、分化等级差、血管或淋巴管浸润、神经侵犯、CA19-9≥37U/mL、术前中性粒细胞/淋巴细胞比值(NLR)≥2.3是预后不良的影响因素。多因素分析结果显示,分化等级差、血管或淋巴管浸润、神经侵犯、NLR≥2.3是预后不良的独立影响因素。利用上述4个临床病理因素建立临床病理因素评分,分为高危组和低危组,发现临床病理因素评分可以有效预测T_2N_0M_0期胃癌患者预后,低危组5年生存率为98.46%,10年生存率为98.46%;高危组5年生存率为78.82%,10年生存率为70.59%。结论分化等级差、血管或淋巴管浸润、神经侵犯、NLR≥2.3是预后不良的独立影响因素,临床病理因素评分可以有效预测T_2N_0M_0期胃癌患者生存状况。

Objective To explore the independent prognostic risk factors affecting T_2N_0M_0 gastric cancer and to construct the clinical pathological factors score system for predicting the prognosis in the patients with T_2N_0M_0 gastric cancer.Methods The clinical data in 215 patients with T_2N_0M_0 gastric cancer treated by radical resection and with complete follow-up data during 2006-2013 were collected and performed the retrospective analysis.The survival rate was calculated by using the Kaplan-Meier method.The Log-rank method was used to compare the survival rates.The Cox model was used to conduct the multivariate analysis for finding out the independent prognostic risk factors.The T_2N_0M_0 gastric cancer clinical pathological factors score system was established.Then the prognosis in the patients with this pathological stage was judged according to the scores.Results The 5-year and 10-year overall survival rates of patients were 90.69% and 87.40% respectively.The univariate analysis results showed that the poorly prognostic factors were tumor diameter≥3cm,the poor differentiation grade,lymphatic and/or blood vessel invasion,perineural invasion,CA19-9≥37U/mL and preoperative neutrophil-to-lymphocyte ratio（NLR）≥2.3.The multivariate analysis results showed that the poor differentiation grade,lymphatic and/or blood vessel invasion positive,perineural invasion positive and NLR≥2.3 were the independent influencing factors of poor prognosis.The above 4clinical pathological factors were used to establish the clinical pathological factors score,dividing into the high risk group and low risk group.Finding the clinical pathological factors score could effectively predict the prognosis of the patients with T_2N_0M_0 gastric cancer.The 5-year survival rate was 98.46% and the 10-year survival rate was 98.46% in the low-risk group.The 5-year survival rate was 78.82% and the 10-year survival rate was 70.59% in the high-risk group.Conclusion The poor differentiation grade,lymphatic and/or blood vessel invasion,perineural invasion and NLR≥2.3 are the independent influence factors of poor prognosis.The clinical pathological factors score can effectively predict the survival status of the patients with T_2N_0M_0 gastric cancer.