105例残胃癌临床病理学特征及预后分析

Analysis of clinicopathological characteristics and prognostic factors of gastric stump cancer in 105 patients

目的:残胃癌是一种特殊类型的胃癌。由于确诊时通常已处于进展期,多数残胃癌患者的预后较差。本文旨在探讨残胃癌患者的临床病理学特征及与预后的关系。方法:回顾性分析2004年5月至2017年7月天津医科大学肿瘤医院收治的105例残胃癌患者的临床病理和预后资料。结果:1)初次疾病良性组残胃癌(GSC-B)与初次疾病恶性组残胃癌(GSC-M)的临床病理特征比较:两组患者的发病年龄分别为(63.22±8.95)岁和(58.93±10.06)岁;男女比例分别为17.5:1和2.6:1;初次手术至诊断残胃癌的时间间隔分别为(390.95±95.18)个月和(64.53±73.15)个月;检出淋巴结总数分别为(17.6±12.5)个和(6.2±6.5)个;肿瘤分化良好型与分化不良型比例分别为0.89:1和0.20:1。上述指标进行比较,差异均有统计学意义(均P<0.05)。2)残胃癌吻合口组与非吻合口组相比:各临床病理学特征比较,差异均无统计学意义(均P>0.05)。3)单因素生存分析显示:远处转移及R0切除术是残胃癌患者预后的相关因素;多因素生存分析发现,R0切除术是影响残胃癌患者生存的独立预后因素。结论:GSC-M与GSC-B组患者临床病理特征有所不同,但预后无显著差异。对于不能进行根治性切除的残胃癌,姑息手术并无生存获益。R0切除术是残胃癌患者的独立预后因素。

Objective: To investigate the clinicopathological characteristics and prognostic factors of gastric stump cancer (GSC). Methods: Clinicopathological data of 105 patients diagnosed with GSC at Tianjin Medical University Cancer Institute and Hospital between May 2004 and July 2017 were retrospectively analyzed. Results: Comparison of clinicopathological features of GSC-B and GSC-M: the average ages of the patients in the GSC-B and GSC-M groups were (63.22±8.95) and (58.93±10.06) years, respectively, and the male: female ratios in the GSC-B and GSC-M groups were 17.5:1.0 and 2.6:1.0, respectively. The time intervals from initial surgery to the diagnosis of GSC in the two groups were (390.95±95.18) and (64.53±73.15) months, respectively;the numbers of lymph nodes harvested in the GSC-B and GSC-M groups were 17.6±12.5 and 6.2±6.5, respectively;and the ratios of well differentiation to poor differentiation in the GSC-B and GSC-M groups were 0.89:1 and 0.20:1, respectively. The differences between all the above factors were statistically significant (P<0.05). Comparison of clinicopathological features of the anastomotic site group and non-anastomotic site group: there was no statistical difference between all the clinicopathological features (P >0.05). Univariate analysis showed that distant metastasis and R0 resection were prognostic factors in the patients with GSC. Multivariate analysis showed that R0 resection was an independent prognostic factor in the patients with GSC. Conclusions: The clinicopathological features of patients in the GSC-B and GSC-M groups were different. Patients with GSC would not benefit from palliative surgery if they could not receive radical surgery. R0 resection is an independent prognostic factor for patients with GSC.