癌栓及D-二聚体水平与胃癌患者的临床病理特征及预后关系

Clinicopathologic characteristics and prognosis of vascular cancer thrombus and D-dimer level in patient with gastric cancer

目的分析伴或不伴癌栓胃癌患者的临床病理特征与预后的关系及血浆D-二聚体水平在胃癌合并脉管癌栓患者中的临床意义。方法回顾性分析2012年1月至2015年12月期间于成都市第三人民医院接受根治性手术切除且均经病理学检查证实为胃癌患者的临床病理资料。结果本研究共纳入295例胃癌切除术患者,不伴癌栓者250例,伴癌栓者45例。多因素分析结果显示,肿瘤浸润深度、淋巴结转移和D-二聚体水平是胃癌发生癌栓的独立影响因素(P<0.050);Cox多因素分析结果发现,原发胃癌淋巴结转移、TNM高分期、高D-二聚体水平、存在脉管癌栓是影响总体胃癌患者预后的独立危险因素(P<0.050),淋巴结转移、TNM高分期、高D-二聚体水平是影响伴癌栓胃癌患者预后的独立危险因素(P<0.050)。不伴癌栓及D-二聚体水平低的胃癌患者的生存情况明显优于伴癌栓及D-二聚体水平高的胃癌患者(癌栓情况:50.3个月比40.5个月,χ~2=20.489,P=0.001;D-二聚体水平:53.3个月比43.0个月,χ~2=12.670,P<0.001)。结论术前监测D-二聚体水平对评估胃癌患者癌栓形成、判断预后有一定的参考价值。

Objective To analyze relationship between clinicopathologic features and prognosis of gastric cancer with or without vascular cancer thrombus and investigate clinical significances of plasma D-dimer in gastric cancer patient with vascular cancer thrombus. Method The clinicopathologic data of patients with gastric cancer who underwent the radical resection in The Third People’s Hospital of Chengdu City from January 2012 to December 2015 were analyzed.Results In this study, 295 patients with gastric cancer were enrolled, of which 250 without vascular cancer thrombus and45 with vascular cancer thrombus. The results of multivariate analysis showed that the depth of invasion, lymph node metastasis, and D-dimer level were the independent influencing factors for the occurrence of vascular cancer thrombus in the patients with gastric cancer(P<0.050). The results of Cox multivariate analysis showed that the lymph node metastasis,high TNM stage, high D-dimer level, and presence of vascular cancer thrombus were the independent risk factors for the overall prognosis of patients with gastric cancer(P<0.050). The lymph node metastasis, high TNM stage, and high D-dimer level were the independent risk factors for the prognosis of gastric cancer patients with vascular cancer thrombus(P<0.050). The survival time of the gastric cancer patients with vascular cancer thrombus or with higher D-dimer level was significantly lower than that of the patients without vascular cancer thrombus or with lower D-dimer level(vascular cancer thrombus: 40.5 months versus 50.3 months, χ^2=20.489, P=0.001;D-dimer level: 43.0 months versus53.3 months, χ^2=12.670, P<0.001). Conclusion Preoperative monitoring of D-dimer level has a certain reference value in evaluating formation of vascular cancer thrombus and judging prognosis in patient with gastric cancer.