术后辅助放疗对中晚期胃印戒细胞癌患者预后的影响:基于人群的回顾性研究

Prognostic impact of postoperative adjuvant radiotherapy on patients with advanced gastric signet ring cell carcinoma:a population-based retrospective study

目的探讨术后辅助放疗对中晚期胃印戒细胞癌患者预后的影响。方法收集监测、流行病学与最终结果(SEER)数据库中2004-2015年1694例中晚期胃印戒细胞癌患者的信息,将患者分为术后放疗组与术后未放疗组。利用Kaplan-Meier法分析两组患者的生存情况,采用log-rank检验和Cox回归进行生存分析与亚组分析。结果Kaplan-Meier生存曲线显示术后放疗组患者的预后较术后未放疗组患者好(P<0.05)。log-rank单因素分析结果显示,年龄、种族、婚姻状况、肿瘤TNM分期、T分期、N分期、肿瘤原发部位、肿瘤最大径及是否接受化疗和术后是否接受放疗是中晚期胃印戒细胞癌患者预后的影响因素(P均<0.01),进一步多因素Cox回归分析显示年龄、T分期、N分期、肿瘤最大径、是否接受化疗及术后是否接受放疗是患者预后的独立影响因素(P均<0.01)。亚组分析结果显示除N0期患者(P>0.05)外,年龄≤70岁与>70岁、不同T分期、有淋巴结转移(N1~N3期)、肿瘤最大径≤5 cm与>5 cm、接受化疗与未接受化疗的患者均能从术后辅助放疗中获益(P均<0.01)。结论对于行手术治疗的中晚期胃印戒细胞癌患者,术后接受辅助放疗患者的预后较未接受放疗者好。

Objective To investigate the effect of postoperative adjuvant radiotherapy on the prognosis of patients with advanced gastric signet ring cell carcinoma.Methods The data of 1694 patients with advanced gastric signet ring cell carcinoma were collected from the Surveillance,Epidemiology,and End Results(SEER)database between 2004 and 2015.The patients were divided into 2 groups,with or without postoperative radiotherapy.Kaplan-Meier method was used to analyze the survival of patients in the 2 groups.Log-rank test and Cox regression were used for survival analysis and subgroup analysis.Results Kaplan-Meier survival curves showed that the prognosis of patients with postoperative radiotherapy was better than that without postoperative radiotherapy group(P<0.05).Log-rank univariate analysis showed that age,race,marital status,TNM stage,T stage,N stage,primary tumor location,maximum tumor diameter,whether to receive chemotherapy or not and whether to receive postoperative radiotherapy or not were the prognostic factors for advanced gastric signet ring cell carcinoma patients(all P<0.01).Multivariate Cox regression analysis showed that age,tumor T and N stages,maximum tumor diameter,whether to receive chemotherapy or not and whether to receive postoperative radiotherapy or not were independent prognostic factors(all P<0.01).Subgroup analysis showed except for N0 group(P>0.05),patients with age≤70 years and>70 years,different T stages,lymph node metastasis(N1-N3),maximum tumor diameter≤5 cm and>5 cm,receiving chemotherapy and those who did not receive chemotherapy,could benefit from postoperative adjuvant radiotherapy(all P<0.01).Conclusion For advanced gastric signet ring cell carcinoma patients who have received surgery,the prognosis of those with postoperative radiotherapy is better than that without postoperative radiotherapy.