残胃癌的临床病理特点及预后因素分析

Prognostic factors for gastric stump cancer

目的分析残胃癌的临床特点及影响预后的因素。方法回顾性分析1995年1月至2014年12月福建医科大学附属泉州市第一医院收治的126例残胃癌患者的临床病理资料,对患者的性别、肿瘤部位、肿瘤大小、临床病理分期以及治疗方式等因素进行预后分析。结果行毕Ⅱ式消化道重建的患者更容易发生残胃癌,占69.8%;癌肿好发于吻合口及周围,占62.3%。126例残胃癌患者的1、3、5年生存率分别为90.4%、57.9%、41.2%。根治性手术组97例残胃癌患者术后的1、3、5年总生存率分别为96.9%、74.2%、53.6%;姑息性手术组29例残胃癌患者术后的1、3、5年总生存率分别为69.0%、3.4%、0,差异均有统计学意义(均P<0.01)。单因素分析结果显示,肿瘤大小、肿瘤浸润深度、淋巴结转移情况、是否有远处器官转移、TNM分期、组织学类型、治疗方式及是否化疗均与患者预后有关(均P<0.01)。多因素分析结果表明,根治性手术切除和化疗为残胃癌患者预后的保护性因素(P<0.01)。结论残胃癌好发于行毕Ⅱ式消化道重建的远端胃大部切除术患者,根治性手术切除是治疗其有效方法。

Objective To analyze the clinical characteristics and prognostic factors of gastric stump cancer.Method The clinical data of 126 gastric stump cancer patients from Jan 1995 to Dec 2014 were collected.We analyzed the survival and prognosis of patients in terms of gender,tumor location,size,clinicopathological stage and treatment methods.Results For primary surgery,B-ⅡGI reconstruction were more likely associated with gastric stump cancer,accounting for 69.8%of the total cases,and cancer was more likely to occur at the anastomotic stoma and in its vicinity,accounting for 62.3%.The 1'-,3'-,and 5-year survival rates of 126 patients were 90.4%,57.9%,and 41.2%,respectively.The 1'-,3'-and 5-year overall survival rates in radical operation group were 96.9%,74.2%and 53.6%respectively,while it was 69.0%,3.4%and 0 respectively in palliative operation group(all P<0.01).Univariate analysis showed that tumor size,invasion depth,lymph node metastasis,distant organ metastasis,TNM stage,histological type,treatment mode and chemotherapy were related to the prognosis(all P<0.01).By multivariate analysis,radical resection and chemotherapy were protective factors for the prognosis(P<0.01).Conclusion Most gastric stump cancer are associated with distal subtotal gastrectomy and B-Ⅱreconstruction.Radical resection is an effective therapy for gastric stump cancer.