基于SEER数据库的胃印戒细胞癌临床病理特征及预后分析

Clinicopathlogic features and prognosis of the gastric signet ring cell carcinoma: a SEER database analysis

目的晚期胃印戒细胞癌(SRCC)预后相比其他类型胃癌较差。文中借助SEER数据库探讨胃SRCC与胃非SRCC患者临床病理特征及预后,并分析不同治疗方式下I期胃SRCC患者生存差异。方法通过监测、流行病学和结果数据库(SEER)收集2010-2015年5193例诊断为胃癌患者的临床资料,并根据组织类型分为SRCC组(n=2439)和非SRCC组(n=2754)。比较组间性别、年龄、人种、原发部位、分化程度、肿瘤大小、浸润深度、局部淋巴结转移、远处转移、TNM分期、手术治疗、化疗等差异;采用Cox回归模型分析预后的影响因素。根据治疗方式不同,将胃SRCC和胃非SRCC患者分为手术组和手术辅助化疗组,应用Kaplan-Meier法绘制生存曲线,生存分析采用Log-Rank检验。结果2组胃癌患者性别、年龄、人种、原发部位、分化程度、肿瘤大小、浸润深度、局部淋巴结转移、远处转移、TNM分期、手术治疗、化疗情况差异均有统计学意义(P<0.05)。多因素Cox回归分析显示,年龄(HR:1.417,95%CI:1.273~1.578,P<0.05)、人种(HR:0.91,95%CI:0.825~0.998,P<0.05)、肿瘤大小(HR:1.28,95%CI:1.199~1.365,P<0.05)、浸润深度(HR:1.252,95%CI:1.159~1.352,P<0.05)、局部淋巴结转移(HR:0.862,95%CI:0.810~0.918,P<0.05)、远处转移(HR:1.369,95%CI:1.069~1.753,P<0.05)、TNM分期(HR:1.342,95%CI:1.155~1.559,P<0.05)、手术治疗(HR:0.245,95%CI:0.228~0.284,P<0.05)为影响胃印戒细胞癌患者预后的独立危险因素。胃SRCC患者总体5年生存率为27.6%,低于胃非SRCC患者(43.0%),差异有统计学意义(P<0.05)。I期胃SRCC和胃非SRCC手术、手术辅助化疗组患者的5年生存率分层分析显示,TIN1M0期、T2N0M0期胃SRCC手术辅助化疗组5年生存率优于手术组,差异有统计学意义(P<0.05);T2N0M0期胃SRCC手术辅助化疗组5年生存率优于胃非SRCC患者,差异有统计学意义(P<0.05)。结论胃SRCC患者具有独特的临床病理特征。早发现、早治疗可改善胃SRCC患者预后。

Objective Prognoses of late stage signet-ring cell carcinoma(SRCC)is usually worse than that in other gas-tric carcinoma.In the current study,SEER database were adopted to analyze the clinicopathologic features and prognoses of SRCC and non-signet-ring cell carcinoma(non SRCC),and to compare the differences in survival rate under different early treatments.Methods Clinical data of 5193 patients who were diagnosed with gastric carcinoma from 2010 to 2015 are collected from SEER.Pa-tients are divided into two groups SRCC(n=2439)and non SRCC(n=2754)based on their histologic type.Differences in Gender,age,race,primary site,degree of differentiation,tumor size,depth of in-vasion,local lymph node metastasis,distant metastasis,tumor,node,metastasis(TNM)staging,operative treatment and chemother-apy were compared.Cox regression model was used to analyze prognostic factors.According to different operative treatment,patients in SRCC and non SRCC groups were divided into surgery group and surgery with adjuvant chemotherapy group,respectively.Kaplanmeier method was used to draw the survival curve,and Log-Rank test was adopted for survival analysis.Results Significant statisti-cal difference(P<0.05)were found in the two gastric carcinoma groups regarding gender,age,race,primary site,degree of differenti-ation,tumor size,depth of invasion,local lymph node metastasis,distant metastasis,TNM staging,operative treatment and chemo-therapy.The multivariate Cox regression analysis indicated that age(HR:1.417;95%CI:1.273-1.578;P<0.05),race(HR:0.91;95%CI:0.825-0.998;P<0.05),tumor size(HR:1.28;95%CI:1.199-1.365;P<0.05),depth of invasion(HR:1.252:95%CI:1.159-1.352;P<0.05),local lymph node metastasis(HR:0.862;95%CI:0.81-0.918;P<0.05),distant metastasis(HR:1.369:95%CI:1.069-1.753;P<0.05),TNM stage(HR:1.342;95%CI:1.155-1.559;P<0.05),and surgical treatment(HR:0.245;95%CI:0.228-0.284;P<0.05)are independent risk factors affecting the prognosis of SRCC patients.The overall five-year survival rate of SRCC patients is 27.6%,which is lower than that of non SRCC patients(43.0%).Therefore,there is significant difference in statistics(P<0.05).Significant statistical difference was also found in stratification analysis of the five-year survival rates among SRCC surgery group,SRCC surgery with adjuvant chemotherapy group,non SRCC surgery group and non SRCC surgery with adjuvant che-motherapy group.The results indicated that the five-year survival rates of SRCC surgery with adjuvant chemotherapy group at stage TIN1M0 and stage T2N0M0 are both superior to that in the surgery group with statistical difference(P<0.05).In addition,the fiveyear survival rate of SRCC surgery with adjuvant chemotherapy group at T2N0M0 is superior to that in the non SRCC patients,with sta-tistical difference(P<0.05).Conclusion SRCC patients present with unique clinicopathologic features.Early detection and treat-ment could improve the prognosis of SRCC patients.