摘要
目的探讨辅助化疗是否对所有pT1N1M0(ⅠB期)的胃癌患者有生存获益。方法回顾性分析2010年1月至2016年12月在河南省肿瘤医院经手术切除并经病理学证实的185例pT1N1M0胃癌患者的临床资料,根据是否进行辅助化疗分为化疗组(n=100)和非化疗组(n=85)。结果单因素生存分析显示:年龄、送检淋巴结数目、脉管侵犯、神经侵犯及辅助化疗均与胃癌患者的无病生存有关(均P<0.05);多因素生存分析显示:送检淋巴结数目≥16枚(HR=0.363,95%CI:0.160~0.827,P=0.016)、脉管侵犯(HR=4.117,95%CI:1.796~9.436,P=0.001)及辅助化疗(HR=4.530,95%CI:1.932~10.622,P=0.001)均是影响胃癌患者无病生存的独立危险因素。单因素生存分析显示:送检淋巴结数目、脉管侵犯、神经侵犯及辅助化疗均与胃癌患者的疾病特异性生存有关(均P<0.05);多因素生存分析显示:送检淋巴结数目≥16枚(HR=0.344,95%CI:0.144~0.822,P=0.016)、脉管侵犯(HR=5.113,95%CI:2.029~12.887,P=0.001)和辅助化疗(HR=4.694,95%CI:1.854~11.888,P=0.001)均是影响胃癌患者疾病特异性生存的独立危险因素。根据两个重要的预后因素(送检淋巴结数目和脉管侵犯)将pT1N1M0患者分为高、中、低3个风险类别,发现3个风险组之间的无病生存和疾病特异性生存差异均有统计学意义(均P<0.001)。结论诊断为pT1N1M0的胃癌患者有望从辅助化疗中生存获益;淋巴结送检数目不足16枚和脉管侵犯的患者可能特别适合辅助化疗。
Objective To investigate whether adjuvant chemotherapy could be beneficial for patients with pT1N1M0(stageⅠB)gastric cancer.Methods From Jan 2010 to Dec 2016,185 patients with pT1N1M0 gastric cancer who were surgically resected at Henan Cancer Hospital were retrospectively analyzed.The patients were divided into chemotherapy group(n=100)and non chemotherapy group(n=85).Results For disease-free survival(DFS)analysis,univariate survival analysis showed that age,examined lymph nodes,vascular invasion,nerve invasion and adjuvant chemotherapy were associated with DFS(all P<0.05);multivariate analysis showed that lymph node resection≥16(HR=0.363,95%CI:0.160-0.827,P=0.016),vascular invasion(HR=4.117,95%CI:1.796-9.436,P=0.001)and postoperative chemotherapy(HR=4.530,95%CI:1.932-10.622,P=0.001)were independent risk factors for DFS.For disease-specific survival(DSS)analysis,univariate survival analysis showed that lymph node resection,vascular invasion,nerve invasion and adjuvant chemotherapy were associated with DSS;multivariate analysis showed that lymph node resection≥16(HR=0.344,95%CI:0.144-0.822,P=0.016),vascular invasion(HR=5.113,95%CI:2.029-12.887,P=0.001)and postoperative chemotherapy(HR=4.694,95%CI:1.854-11.888,P=0.001)were independent risk factors for DSS.According to examined lymph nodes and vascular invasion,pT1N1M0 patients were divided into three risk categories(high,medium and low).DFS and DSS were significantly different among the three risk groups(all P<0.001,respectively).Conclusion pT1N1M0 gastric cancer patients are expected to benefit from adjuvant chemotherapy.Patients with less than 16 lymph nodes and vascular invasion may be particularly suitable for adjuvant chemotherapy.
作者
李森
马鹏飞
张俊立
曹养辉
刘晨宇
张习杰
薛英威
赵玉洲
Li Sen;Ma Pengfei;Zhang Junli;Cao Yanghui;Liu Chenyu;Zhang Xijie;Xue Yingwei;Zhao Yuzhou(Department of General Surgery,the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China;Department of Gastroenterological Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2021年第4期254-258,共5页
Chinese Journal of General Surgery
基金
河南省高等学校重点科研项目 (20A320016)。
关键词
胃肿瘤
肿瘤辅助治疗
预后
肿瘤分期
Stomach neoplsms
Neoadjuvant therapy
Prognosis
Neoplasm staging