脉管癌栓等临床病理因素对胃癌预后的相关性分析

Prognosis analysis of lymphovascular invasion and other clinicopathological risk factors

目的分析脉管癌栓与其他临床病理因素的关系及其对胃癌预后的影响。方法回顾性分析621例胃癌患者的临床病理资料,根据患者是否存在脉管癌栓将其分为脉管癌栓阳性组和脉管癌栓阴性组。比较两组胃癌患者5年累积生存率的差异,分析脉管癌栓与其他临床病理因素的关系及其对胃癌预后的影响。结果621例胃癌患者中,脉管癌栓发生率为31.7%(197例),二分类Logistic回归分析显示,肿瘤的分化程度、浸润深度、淋巴结转移是发生胃癌脉管癌栓的独立影响因素(P<0.01)。趋势χ^2检验显示,肿瘤的分化程度、浸润深度、淋巴结转移与胃癌脉管癌栓阳性率呈线性相关关系(P<0.01),其中淋巴结转移与脉管癌栓的相关性更显著(r=0.387)。单因素分析显示,脉管癌栓阳性组术后5年累积生存率显著低于脉管癌栓阴性组,差异有统计学意义(46.7%vs 73.3%,P<0.01)。多因素分析显示,年龄、肿瘤直径、TNM分期、脉管癌栓是影响胃癌患者预后的独立危险因素(P均<0.05)。进一步分层分析显示,在Ⅲ期胃癌患者中脉管癌栓阳性组5年累积生存率低于脉管癌栓阴性组,差异有统计学意义(36.1%vs 51.4%;P<0.05)。结论脉管癌栓是影响胃癌患者预后的独立危险因素,结合脉管癌栓与TNM分期可更好地判断胃癌患者的预后,指导更合理的治疗。

Objective To analyze the connection between lymphovascular invasion(LVI)and other clinicopathological factors and its effect on the prognosis of gastric cancer.Methods Clinicopathological data of 621 patients were retrospectively analyzed.According to the presence of LVI,the patients were divided into two groups:LVI positive(LVI+)group and LVI negative(LVI-)group.The 5-year cumulative survival rate of the two groups were compared.Meanwhile the connection between LVI and other clinicopathological factors and its effect on the prognosis of gastric cancer were analyzed.Results The incidence of LVI was 31.7%(197 cases)among the 621 patients.Binary logistic regression analysis showed significant correlation between LVI and the degree of tumor differentiation,depth of invasion and the presence of lymph node metastasis(P<0.01).Trendχ^2 test showed that there was linear correlation between degree of tumor differentiation,depth of invasion,lymph node metastasis and the positive rate of LVI in gastric cancer(P<0.01),and the correlation between lymph node metastasis and LVI was more significant(r=0.387).The 5-year cumulative survival rate in the LVI+group was significantly lower than that in the LVI-group,and the difference was statistically significant(46.7%vs 73.3%;P<0.01).A multivariate analysis also identified age,diameter of tumor,TNM stage and LVI as the independent prognostic factors for patients with gastric cancer(P<0.05).In further stratified analysis,the 5-year cumulative survival rate of the LVI+group was significantly lower than that of LVI-group in patients at stageⅢ(36.1%vs 51.4%;P<0.05).Conclusions LVI is an independent indicator for poor prognosis of gastric cancer.The combination of LVI and TNM staging could predict the prognosis of patients with gastric cancer more accurately.