胃印戒细胞癌预后及手术方式的临床研究

Clinical study of the prognosis and surgical methods of signet-ring cell carcinoma of the stomach

目的探究胃印戒细胞癌(SRCC)的预后影响因素及手术切除范围的选择。方法回顾性分析2011年8月至2014年12月于我院行根治性胃癌切除术的180例SRCC患者的临床病理资料,所有患者均经术后病理证实。采用COX回归模型分析影响患者预后的因素。并将180例患者按手术切除范围不同分为全胃切除组(n=70)和部分胃切除组(n=110),应用Kaplan-Meier法绘制生存曲线,生存曲线之间的比较采用Log-Rank检验。结果单因素分析结果显示,性别、脉管神经浸润显著影响患者3年生存期(P<0.05);年龄、肿瘤部位、肿瘤大小、手术方式、T分期、N分期均极显著影响患者生存期(P<0.01)。多因素分析结果显示,年龄、T分期、N分期及手术方式是胃印戒细胞癌预后的独立影响因素(P<0.05)。180例患者的3年总体生存率为62.8%,其中全胃切除组3年生存率为45.7%,明显低于部分胃切除组3年生存率71.8%,且术后并发症发生率较高(P<0.05)。分层分析显示,TNMⅠ、Ⅱ期患者,手术方式与预后未见明显相关(P>0.05);TNMⅢ期患者,全胃切除组预后较差(P<0.05)。结论高龄、进展T分期、进展N分期、全胃切除是胃印戒细胞癌预后的独立影响因素。在保证R0切除的基础上,部分胃切除术能降低胃印戒细胞癌术后并发症发生风险,提高预后水平。

Objective To explore the prognostic factors and choice of surgical resection scope of stomach signet-ringcell carcinoma （SRCC）. Methods The clinical data of 180 SRCC patients who underwent radical gastrectomy in our hospitalfrom August 2011 to December 2014 were analyzed retrospectively. All the patients were confirmed by postoperativepathology. The COX regression model was used to analyze the prognostic factors. A total of 180 patients were divided intototal gastrectomy group （n=70） and partial gastrectomy group （n=110） according to the different surgical excision range. Thesurvival curves were plotted by Kaplan-Meier, and Log-Rank test was used to compare the survival curves. Results Thesingle factor analysis showed that the 3 year survival period of the patients was significantly affected by sex and vascularnerve infiltration （P〈0.05）. Age, tumor location, tumor size, operation mode, T stage and N staging all significantly affectedthe patient＇s survival time （P〈0.01）. The multiple factor analysis showed that age, T stage, N staging and operation modewere the independent influence factors of prognosis of stomach SRCC（P〈0.05）. The total 3-year survival rate of the 180patients was 62.8%. The 3-year survival rate of the total gastrectomy group was 45.7%, which was significantly lower than71.8% of the partial gastrectomy group, and the incidence of postoperative complications of the total gastrectomy group washigher（P〈0.05）. The stratified analysis showed that there was no significant correlation between the mode of operation andprognosis in phase I and stage II patients （P〉0.05）; but the prognosis of the total gastrectomy group was poorer in stage IIIpatients （P〈0.05）. Conclusion Advanced age, progression of T stage, progression of N stage and total gastrectomy are theindependent factors affecting the prognosis of stomach SRCC. On the basis of R0 resection, partial gastrectomy can reducethe risk of postoperative complications and improve the prognosis of stomach SRCC.