脉管浸润在胃癌患者预后预测中的作用

Role of lymphovascular invasion in predicting the prognosis of patients with gastric cancer

目的探讨脉管浸润在胃癌患者预后预测中的作用。方法回顾性分析2012年1月至2017年1月在陕西省人民医院普外科接受根治性胃癌手术患者的临床资料,采用HE染色和免疫组化两种方法对患者进行脉管浸润的评估。采用χ2检验分析脉管浸润与患者临床病理特征之间的关系,采用单因素和多因素分析法来确定影响患者无病生存期和总生存期的预后因素。结果在273例胃癌手术患者中,26.0%(71/273)被诊断为脉管浸润,22例为单纯的血管浸润,25例为单纯的淋巴管浸润,剩余24例患者同时存在淋巴管与血管浸润。进一步分析发现,随着肿瘤TNM分期的升高,脉管浸润的发生率呈递增趋势,从Ⅰ期胃癌的7.7%上升到Ⅲ期胃癌的36.8%(P<0.05);脉管浸润还与胃癌的肿瘤部位、病理T分期和病理N分期有关(P<0.05)。脉管浸润是胃癌患者无病生存期(相对风险比为1.5,95%置信区间为1.1~2.2,P=0.018)和总生存期(相对风险比为1.8,95%置信区间为1.3~2.6,P=0.001)的独立预测因子。结论脉管浸润是可手术胃癌患者复发和转移的高危因素,同时也是胃癌预后不佳的独立预测因子,在完善胃癌的TNM分期和监测术后复发转移中发挥重要作用。

Objective To explore the role of lymphovascular invasion in predicting the prognosis of patients with gastric cancer.Methods The clinical data of patients who underwent radical gastric cancer surgery in the general surgery department of Shaanxi provincial people's hospital from January 2012 to January 2017 were retrospectively analyzed.The lymphovascular invasion was evaluated by two methods of HE staining and immunohistochemistry.Theχ2 test was used to analyze the relationship between lymphovascular invasion and clinicopathological features of the patients,and univariate and multivariate analyses were used to determine the prognostic factors affecting disease-free survival and overall survival of the patients.Results Among the 273 patients undergoing surgery for gastric cancer,26.0%(71/273)were diagnosed as lymphovascular invasion,including 22 cases of simple vascular invasion,25 cases of simple lymphatic invasion,and 24 cases of both lymphatic and vascular invasion.Further analysis showed that,with the increase of TNM stage,the incidence of lymphovascular invasion increased from 7.7%of stageⅠgastric cancer to 36.8%of stageⅢgastric cancer(P<0.05);lymphovascular invasion were also related to tumor location,pathological T stage and pathological N stage of gastric cancer(P<0.05).Lymphovascular invasion was an independent predictor of disease-free survival(relative risk ratio:1.5,95%confidence interval:1.1-2.2,P=0.018)and overall survival(relative risk ratio:1.8,95%confidence interval:1.3-2.6,P=0.001).Conclusion Lymphovascular invasion is a high-risk factor for recurrence and metastasis of operable gastric cancer,and is also an independent predictor of poor prognosis of gastric cancer.It plays an important role in improving TNM staging of gastric cancer and monitoring postoperative recurrence and metastasis.