胃腺癌肺转移的相关因素分析及中医证型研究

Study on TCM Pattern and Analysis of the Related Factors of Lung Metastasis of Gastric Adenocarcinoma

目的:分析影响胃腺癌肺转移相关危险因素与中医证型分类,为临床预防及治疗胃癌提供依据。方法:选取2015年1月至2019年6月120例胃腺癌患者的临床资料,观察组(肺部有转移灶)和对照组(肺部无转移灶),每组60例。分析胃腺癌肺转移的危险因素、临床病理学特征及中医证型分类。结果:120例患者中,大部分表现为肺部多发转移病灶,在单因素分析中,年龄≥60岁,肿瘤位于上胃体1/3,原发灶未手术治疗,肿瘤标志物中癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原72-4(CA72-4)升高、有其他器官转移、N分期(Node,区域淋巴结regional lymph node受累情况)为N2-N3的患者胃癌肺转移率较高;在多因素分析中,年龄≥60岁,肿瘤位于胃体上1/3,肿瘤标志物CEA、CA72-4升高,有其他器官转移是胃癌发生肺转移的独立危险因素,原发灶手术治疗是胃癌肺转移的保护因素。中医证型分类方面,脾虚痰湿型在观察组中的比例高于对照组,两组比较差异有统计学意义(P<0.05)。结论:建议年龄≥60岁,肿瘤位于胃体上1/3,肿瘤标志物CEA、CA72-4升高,有其他器官转移,中医辨证为脾虚痰湿的患者三年内行胸部CT进行随访并适时采用健脾、燥湿、化痰、扶正等方法干预。

Objective:To provide the reference for clinical prevention and treatment for gastric adenocarcinoma by analyzing the risk factors for lung metastasis of gastric adenocarcinoma and the classification of TCM patterns.Methods:Clinical data of 120 cases of gastric adenocarcinoma between January,2015 and June,2019 were selected and divided into the observation group(metastases in the lungs)and the control group(no metastases in the lungs),60 cases in each group.To analyze the risk factors for lung metastasis of gastric adenocarcinoma,clinical pathological features and TCM patterns.Results:Among the patients,most of them showed multiple pulmonary metastasis,in univariate analysis,the patients older than 60 years,tumor located in the upper 1/3,primary tumor without surgical treatment,CEA and CA72-4 increased,the metastasis of the other organs,the patients with N stage(node,regional lymph node involvement)N2 to N3 had higher lung metastasis rate;In multivariate analysis,the patients older than 60 years,tumor located in the upper 1/3,tumor markers CEA and CA72-4 increased,other organ metastasis were the indepent risk factors for lung metastasis of gastric cancer,surgical treatment of primary focus was protective factor for lung metastasis of gastric cancer.In the classifications of TCM patterns,the ratio of spleen deficiency and phlegm dampness pattern in the observation group was higher than that of the control group relatively,and the difference had statistical meaning.Conclusion:It is suggested that patients older than 60 years,tumor located in the upper 1/3,tumor markers CEA and CA72-4 increasing,other organ metastasis,TCM syndrome differentiaion as spleen deficiency and phlegm dampness should be followed up by chest CT within three years,intervened with the methods of strengthening spleen,drying dampness,resolving phlegm and enhancing healthy Qi timely.