肿瘤-间质比例对胃癌患者预后的预测价值

The predictive value of the tumor-stroma ratio for the prognosis in patients with gastric cancer

目的评估肿瘤-间质比例(TSR)对胃癌患者预后的预测价值。方法收集216例接受D2根治术的胃癌患者的临床资料,比较少间质(TSR﹥1)和多间质(TSR≤1)患者的临床特征及生存情况,分析影响患者总生存率和无进展生存率的危险因素。结果 81例(37.5%)患者为少间质,135例(62.5%)患者为多间质。少间质和多间质患者的T分期、N分期、淋巴结转移个数、阳性淋巴结比例(LNR)、神经浸润情况和淋巴微管浸润情况比较,差异均有统计学意义(P﹤0.01)。多间质患者的5年总生存率为25.9%,明显低于少间质患者的81.5%,差异有统计学意义(P﹤0.01);多间质患者的5年无进展生存率为19.2%,明显低于少间质患者的72.8%,差异有统计学意义(P﹤0.01)。多因素分析结果显示,T分期为T3～T4期和多间质是影响胃癌患者总生存率和无进展生存率的危险因素(P﹤0.05)。结论 TSR是胃癌患者根治性切除术后远期预后的独立影响因素,可为术后辅助治疗方案的制订提供重要依据。

Objective To evaluate the prognostic value of tumor-stroma ratio(TSR)in gastric cancer patients.Method The clinical data of 216 patients with D2 radical resection of gastric cancer were collected,of which the clinical characteristics and survival were compared after being stratified by TSR as stroma-poor group(TSR>1)and stroma-rich group(TSR≤1),besides,the factors influencing the overall survival(OS)and progression-free survival(PFS)between the two groups were compared.Result There were 81(37.5%)patients classified as stroma-poor while 135(62.5%)patients grouped as stroma-rich in the analysis.Patients in the two TSR groups had statistically significant difference regarding T stage,N stage,number of metastatic lymph nodes,positive lymph node ratio(LNR),neural invasion and microlymphatic invasion(P<0.01).The 5-year OS and PFS of stroma-rich patients were 25.9%and 19.2%,which were shorter than that of 81.5%and 72.8%in stroma-poor patients,showing statistically significant differences(P<0.01).Multivariate Cox regression analysis demonstrated that T3-T4 stage and lower TSR were independent risk factors for OS and PFS in patients with gastric cancer(P<0.05).Conclusion TSR is an independent risk factor for the long-term prognosis in patients with gastric cancer and can be applied as a useful indicator when planning the postoperative adjuvant therapy.