基于肿瘤浸润深度及大小的TTS评分系统对可切除胃癌患者预后判断的价值

The value of TTS scoring system based on tumor depth and size in prognosis of resectable gastric cancer

目的:探讨基于肿瘤浸润深度及大小的TTS评分系统对可切除胃癌患者预后判断的价值。方法:选择行根治性切除的234例胃癌患者为研究对象。根据肿瘤浸润深度(T分期)和肿瘤大小构建TTS评分系统,分为TTS 0级、1级、2级,代表肿瘤侵袭性逐渐升高。通过Cox多因素模型分析TTS评分系统作为预后判断工具的可行性。结果:T_(1)-T_(4)期患者肿瘤的平均大小分别为(3.3±2.7)cm、(4.1±3.1)cm、(6.6±3.1)cm、(9.4±4.9)cm。单因素分析显示,肿瘤浸润深度与肿瘤大小、淋巴结转移、TNM分期、淋巴浸润和血管浸润显著相关(P<0.01)。ROC曲线显示,45 mm为肿瘤大小的最佳界值,可有效区分患者是否存在淋巴结转移,曲线下面积(area under curve,AUC)为0.762。综合肿瘤大小的临界值和肿瘤浸润深度,构建TTS评分系统,TTS 0级、TTS 1级和TTS 2级的患者5年生存率分别为95.6%、83.3%和70.2%,两两比较后发现,不同TTS状态患者的生存率之间均存在显著差异(P<0.01)。Cox多因素分析发现,TTS评分是影响患者预后的独立性危险因素(P<0.05)。结论:本研究根据肿瘤浸润深度和大小构建了TTS评分系统,并证明了TTS评分与胃癌患者的预后密切相关。

Objective:To explore the value of TTS scoring system based on tumor depth and size in the prognosis of gastric cancer patients.Methods:234 patients with gastric cancer were selected as the study object.According to T stage and tumor size,TTS scoring system was constructed,which was divided into 0,1 and 2 levels.To analyze and evaluate the feasibility of TTS as a prognostic tool.Results:The average tumor size of T_(1)-T_(4)patients were(3.3±2.7)cm,(4.1±3.1)cm,(6.6±3.1)cm,(9.4±4.9)cm,respectively.The tumor depth was significantly correlated with tumor size,lymph node metastasis,TNM stage and lymph and vein invasion(P<0.01).ROC curve showed that 45 mm was the best boundary of tumor size,which could effectively distinguish whether there was lymph node metastasis.AUC was 0.762.According to the critical values of tumor invasion depth and tumor size,TTS scoring system was constructed.The 5-year survival rates of TTS 0-2 were 95.6%,83.3%and 70.2%respectively.After comparison,there was a significant difference between the survival rates of patients with different TTS states(P<0.01).Cox multivariate analysis found that TTS score was an independent risk factor for prognosis(P<0.05).Conclusion:According to the depth and size of the tumor,the TTS scoring system is constructed,and it is proved that TTS scoring is closely related to the prognosis of gastric cancer patients.