胃癌根治术后肺转移危险因素分析

A retrospective analysis of lung recurrence after curative resection for gastric cancer

目的探讨影响胃癌术后肺转移的危险因素。方法回顾性分析北京大学肿瘤医院暨北京市肿瘤防治研究所1992年7月至2013年4月诊断为胃腺癌并接受胃癌根治术且具有完整临床和随访的1054例病人资料。分析胃癌术后肺转移的发生率,以及胃癌术后肺转移的发生与临床病理学特征的关系。结果在纳入分析的1054例病人中,35例(3.3%)病人以肺转移为术后首发转移部位,并多见于进展期胃癌。大部分病人表现为肺多发转移病灶。胃癌术后肺转移的中位发生时间为13.2个月[四分位距(IQR)6.37,21.33]。发生肺转移后,中位总生存时间为18.8个月(IQR 8.20,36.30)。在单因素分析中,胃癌术后肺转移在年龄>65岁、肿瘤位于上1/3和全胃癌的病人中发生率较高。术后分期N0-1、印戒细胞癌病人术后倾向于出现肺转移(P>0.05)。在多因素分析中,年龄>65岁、肿瘤位于上1/3和全胃是出现胃癌根治术后肺转移的独立危险因素。结论胃癌根治术后肺转移的发生率较低,且预后较其他转移略好。推荐年龄>65岁、肿瘤位于上1/3胃和全胃的胃癌病人在术后3年内行胸部CT进行随访。

Objective Systematical analysis for lung recurrence has not yet been established for gastric cancer after surgical resection.The aim of this study was to investigate the incidence of and related risk factors for lung recurrence after surgical resection of gastric cancer. Methods A cohort of 1054 gastric adenocarcinoma patients after curative resection without neo-adjuvant chemotherapy was enrolled.Clinicopathological characteristics were retrospective collected.The incidence and the risk factors of lung recurrence after surgical resection of gastric cancer were investigated by software SPSS. Results In a total of 1054 patients analyzed, lung recurrence was detected in 35 patients （3.3%）. Lung recurrence was general observed in advanced gastric cancers.Most patients had multiple lung metastases.The median time for lung recurrence was 13.2 months （interquartile range [IQR] 6.37,21.33） from the surgery.The median survival was 18.83 months （IQR 8.20, 36.30） from the lung recurrence.In univariate analysis, the lung recurrence rate was higher in the tumors with old age （ 〉 65y） , location in the upper third or entire stomach.Patients with N0-1 and signet ring cell cancer showed potential less likelihood of experiencing lung recurrence.In muhivariate analysis, age （ 〉 65y vs. _-〈 65y） was the most predictable risk factor for lung recurrence （odds ratio [OR] 2.102,95% confidence interval [CI] 1.046-4.226）.And tumor location （upper third stomach, entire stomach vs.lower third stomach） was also independently associated with lung recurrence.Conclusion The incidence of lung recurrence was low after curative resection in patients with gastric cancer.However, the prognosis of lung recurrence was relative better.Regular follow up with chest computerized tomography （CT） seems to be necessary in those patients with old age （ 〉 65y） and tumors location in upper third and entire stomach, especially within the first 3 years after curative surgery.