非胃肠道表现为首发症状的胃癌危险因素及预后分析

Risk factors and prognosis analysis of gastric cancer among patients with non gastrointestinal manifestations as initial symptoms

目的分析以非胃肠道表现为首发症状的胃癌患者危险因素及预后状况。方法收集2000年1月至2012年1月于温州医科大学附属医院育英儿童医院、温州医科大学附属第一医院、温州市中心医院就诊的胃癌患者940例,根据首发症状类型,将非胃肠道表现为首发症状的患者设为观察组(105例),以胃相关表现为首发症状的患者为对照组(835例),分析两组患者的危险因素及5年生存率情况。结果单因素分析结果显示,年龄、WHO分型、肿瘤大小、TNM分期是影响胃癌首发症状类型的影响因素,差异有统计学意义(χ2=45.98、7.55、14.38、8.00,P<0.05)。进一步行cox回归多因素分析发现,肿瘤大小(P=0.00)、TNM分期(P=0.03)是影响患者首发症状类型的独立性影响因素。观察组与对照组5年生存率分别为34.29%(36/105),55.93%(467/835),差异有统计学意义(χ2=21.300,P=0.000)。贫血组、低热待查组、进行性消瘦组、乏力组5年生存率分别为35.19%(19/54)、33.33%(9/27)、23.53%(4/17)、57.14%(4/7),差异无统计学意义(χ2=6.046,P=0.109)。与对照组比较,贫血组(χ2=14.110,P=0.000),进行性消瘦组(χ2=17.910,P=0.000)患者预后差异有统计学意义。低热待查组(χ2=1.614,P=0.203)、乏力组(χ2=0.023,P=0.879)患者5年生存率与对照组比较差异无统计学意义。结论温州市胃癌患者中以非胃肠道表现为首发症状的患者比例较高,值得临床警惕。肿瘤直径、TNM分期是影响首发症状类型的独立性影响因素。患者若以贫血、低热待查为首发症状,是预后不良的强烈信号。

Objective To analyze the risk factors and prognosis of gastric cancer among patients with non gastrointestinal manifestations as initial symptoms in Wenzhou in 2000-2012. Methods A total of 940 cases with gastric cancer diagnosed in three hospitals in Wenzhou were enrolled into the study from January 2000 to2012.Patients with non gastrointestinal manifestations as initial symptoms were assigned into observation group（n=105）,while those with gastrointestinal manifestations as initial symptoms were enrolled into control group（n=835）.The clinical characteristics and the difference of the prognosis were compared in the two groups. Results Single factor analysis showed that age,WHO classification,tumor size and TNM staging were the risk factors affecting the type of patient′s initial symptoms（χ~2=45.98,7.55,14.38,8.00,P〈0.05）.Multifactor analysis revealed that tumor size（P=0.00）and TNM staging（P=0.03）were independent influencing factors for patient′s initial symptoms.The 5 year survival rates were statistically different between patients in observation group and control group（34.29%vs 55.93%;χ~2=21.300,P=0.000）.There were no significant differences of 5 year survival rates among patients with anemia（35.19%）,low fever of unknown reason（33.33%）,progressive emaciation（23.53%）and with fatigue（57.14%）.Compared with patients in control group,cases with anemia（χ~2=14.110,P=0.000）and progressive emaciation（χ~2=17.910,P=0.000）had significantly poorer disease prognosis,but not those with low fever（χ~2=1.614,P=0.203）and fatigue（χ~2=0.023,P=0.879）. Conclusions There are certain numbers of patients with gastric cancer who manifest initial non gastrointestinal symptoms.The size of tumor and TNM staging are key factors affecting patient′s initial symptoms and those with initial symptoms as anemia or low fever of unknown reason usually have poorer clinical prognosis.