青海地区残胃癌患者的临床特征与预后分析

Analysis of clinical features and prognosis of patients with gastric stump cancer in Qinghai area

目的:探讨青海地区残胃癌(GSC)患者的临床病理特征及预后。方法:回顾性分析2012年1月-2018年10月就诊于青海大学附属医院胃肠外科、青海省人民医院肿瘤外科的102例GSC患者临床资料。结果:102例GSC患者中,首次疾病为良性者20例(19.6%),首次疾病为恶性者82例(80.4%)。首次术后至GSC发生的时间间隔,首次疾病为良性者为204(108~481)个月,首次疾病为恶性者为38(5~204)个月,前者GSC均发生于首次术后60个月后,后者大多数(84.2%)发生于首次术后60个月以内,且两者在首次手术方式、消化道重建方式的构成比方面存在统计学差异(均P<0.05)。首次疾病为良性者GSC主要发生于非吻合口(60.0%),而首次疾病为恶性者主要发生于吻合口(68.3%),差异有统计学意义(P<0.05)。102例患者中,行根治性手术11例(10.8%),姑息性手术19例(18.6%),未手术72例(70.6%)。83例获随访1~50个月,全组GSC患者3年总体生存率为25.5%,患者的生存率与首次疾病的良、恶性无关(P=0.086),而与GSC的病理组织分型、有无合并症以及CEA、CA19-9水平有关(均P<0.05)。结论:GSC的发生与首次手术方式及首次消化道重建方式有关,不同首次疾病性质患者GSC发生的间隔时间及发生部位不同;GSC预后差,GSC的病理组织分型、合并症及部分肿瘤标志物水平对GSC患者的预后有显著的影响。

Objective: To investigate the clinicopathologic features and prognosis of patients with gastric stump cancer(GSC) in Qinghai area. Methods: The clinical data of 102 patients with GSC admitted in the Department of Gastrointestinal Surgery of Affiliated Hospital of Qinghai University and Department of Oncology of Qinghai Provincial People’s Hospital from January 2012 to October 2018 were retrospectively analyzed.Results: Of the patients, the initial disease was benign in 20 cases(19.6%) and was malignant in 82 cases(80.4%). The time interval between the initial operation and the development of GSC in patients with initial benign disease was 204(108 to 481) months, and in those with malignant disease was 38(5 to 204) months, the GSC occurred later than 60 months after the initial operation in all cases in the former and occurred within 60 months after the initial operation in most cases(84.2%) in the latter, and differences also existed between the two groups of patients in the constituent ratios of the initial operation types and digestive tract reconstruction methods(all P<0.05). The GSC mainly occurred beyond the anastomotic stoma(60.0%) in patients with initial benign disease and mainly occurred at the anastomotic stoma(68.3%) in those with malignant disease, and the difference had statistical significance(P<0.05). Among the 102 patients, 11 cases(10.8%) underwent radical surgery, 19 cases(18.6%) underwent palliative surgery and 72 cases(70.6%) not undergo surgery. Follow-up was performed in 83 patients for 1 month to 50 months. The 3-year overall survival rate in the whole group of patients was 25.5%, and the survival rate of the patients showed no significant association with the benign or malignant nature of the initial diseases(P=0.086), but was significantly related to the histopathological type of GSC and presence or absence of concomitant disease as well as the levels of CEA and CA19-9(all P<0.05). Conclusion: The development of GSC is related to the initial operation type and digestive tract reconstruction method. The time interval and site of occurrence of GSC are different between patients with different natures of the initial diseases. The prognosis of GSC is poor, and the histopathological type of GSC, the concomitant diseases and the levels of some tumor markers have significant impacts on the prognosis of the patients.