Borrmann Ⅳ型胃癌的临床病理特点及预后分析

Analysis of clinicopathological features and prognosis of Borrmann type Ⅳ gastric cancer

目的分析BorrmannⅣ型胃癌与非BorrmannⅣ型胃癌的临床病理特点和预后。方法回顾性分析1994年8月至2021年8月在中山大学附属第一医院胃肠外科中心诊治的2525例进展期胃癌患者的临床病理资料,对比BorrmannⅣ型胃癌与非BorrmannⅣ型胃癌的临床病理特点,使用倾向评分匹配(PSM)的方法获得匹配队列,比较两组患者预后的差异;并采用单因素和多因素Cox比例风险模型分析探讨影响BorrmannⅣ型胃癌患者预后的因素。结果2525例胃癌患者中,287例BorrmannⅣ型胃癌和2238例非BorrmannⅣ型胃癌。两组患者在确诊年龄、性别、肿瘤部位、肿瘤直径、病理组织类型、浸润深度、淋巴结转移、有无腹膜种植、TNM分期、手术是否达到R0切除等参数方面差异有统计学意义(P<0.05),在有无肝脏转移、人表皮生长因子受体2(HER-2)表达、微卫星状态、是否接受术后辅助化疗等方面差异无统计学意义(P>0.05);Kaplan-Meier生存分析显示BorrmannⅣ型胃癌术后5年生存率为17.3%,匹配前后的Kaplan-Meier生存分析均提示该类型胃癌患者预后较非BorrmannⅣ型胃癌患者差;多因素Cox比例风险模型分析显示肿瘤侵犯浆膜层或邻近组织(pT4)(HR=1.56,95%CI:1.09~2.23,P=0.015)、pTNMⅣ期(HR=2.00,95%CI:1.44~2.77,P<0.001)是影响患者预后的独立危险因素。结论BorrmannⅣ型胃癌具有侵袭性强、转移率高、根治切除率低等特点,该型胃癌患者的预后差,早期明确诊断并接受根治性手术治疗能较好地改善该类型胃癌患者的预后。

Objective Analyze the clinicopathological features and prognosis of Borrmann typeⅣgastric cancer with non-Borrmann typeⅣgastric cancer.Method The clinicopathological information of 2525 patients with advanced gastric cancer treated in the Department of Gastrointestinal Surgery,the First Affiliated Hospital of Sun Yat-sen University from August 1994 to August 2021 were analyzed retrospectively.The clinicopathological features of Borrmann typeⅣgastric cancer and non-Borrmann typeⅣgastric cancer were compared.The matching cohort was obtained by propensity score matching(PSM),and the prognosis differences between the two groups were compared.Univariate and multivariate Cox proportional hazard models were used to analyze the factors of patients with Borrmann typeⅣgastric cancer.Result Among the 2525 cases of gastric cancer,there were 287 cases of Borrmann typeⅣgastric cancer and 2238 cases of non-Borrmann typeⅣgastric cancer.There were significant differences between the two groups in diagnosis age,gender,tumor location,tumor size,histological type,depth of invasion,lymph node metastasis,peritoneal dissemination TNM stage,and R0 resection(P<0.05).There was no significant difference in liver metastasis,human epidermal receptor 2(HER-2),microsatellite status and postoperative adjuvant chemotherapy(P>0.05);Kaplan-Meier survival analysis showed that the 5-year survival rate of Borrmann typeⅣgastric cancer was 17.3%.Kaplan-Meier survival analysis before and after matching showed that the prognosis of this type of gastric cancer was worse than that of other Borrmann types of gastric cancer.Multivariate Cox proportional hazard model analysis showed that tumor invasion of the serosa or adjacent structures(pT4)(HR=1.56,95%CI:1.09-2.23,P=0.015)and pTNM stageⅣ(HR=2.00,95%CI:1.44-2.77,P<0.001)were independent risk factors for prognosis,and R0 surgical resection(HR=0.43,95%CI:0.28-0.67,P<0.001)was independent protective factor.Conclusion Borrmann typeⅣgastric cancer has the characteristics of strong invasive capacity,high metastasis rate and low radical resection rate.The prognosis of this type of gastric cancer is poor.Early diagnosis and radical surgery can improve the prognosis of this type of gastric cancer.