近端胃癌患者胃裸区侵犯CT征象与术后中远期生存期的相关性研究

Correlational study between CT signs of the GBA invasion and the postoperatively medium to long term survival in patients with proximal gastric carcinoma

目的:探讨近端胃癌(PGC)患者术前CT检查胃裸区(GBA)侵犯与术后中远期生存期的相关性。方法:选取医院收治的78例经病理活检诊断为胃癌的患者,所有患者术前均行螺旋CT检查评估GBA侵犯程度,分析螺旋CT与手术病理诊断结果的一致性,采用生存分析Kaplan-Meier曲线分析术后中远期生存期情况,采用Cox比例风险模型分析影响胃癌患者近远期生存率的影响因素。结果:螺旋CT诊断近端胃癌GBA区侵犯准确率为80.77%,其诊断结果与手术病理诊断结果具有较好的一致性,差异有统计学意义(Kappa=0.688,P<0.05)。术后随访3年,78例患者中死亡17例,生存61例,其中,胃膈韧带受累、膈肌受累及胃周脂肪受累是影响PGC患者术后3年总生存率的主要危险因素(Logrank=3.395,Log rank=6.373,Logrank=39.164;P<0.05)。单因素分析显示,病程、T临床分期、GBA区淋巴结个数、跨壁受累、胃膈韧带受累、膈肌受累及胃周脂肪层为PGC患者术后3年总生存率的影响因素(x^(2)=6.954,x^(2)=14.190,x^(2)=27.149,x^(2)=7.676,x^(2)=10.880,x^(2)=16.597,x^(2)=7.270;P<0.05)。Cox回归分析显示,临床分期、跨壁受累、胃膈韧带受累、膈肌受累及胃周脂肪层受累为PGC患者术后3年总生存率的独立影响因素(HR=1.286,HR=1.191,HR=1.072,HR=1.270,HR=1.046;P<0.05)。结论:PGC患者GBA区侵犯CT征象能够对患者术后中远期生存情况进行评估,为识别不良预后的高危患者调整治疗方案。

Objective:To investigate the correlation between the invasion of gastric bare area(GBA)of preoperative computed tomography(CT)examination and the postoperatively medium to long term survival in patients with proximal gastric carcinoma(PGC).Methods:A total of 78 patients with gastric carcinoma diagnosed by pathological biopsy were selected.All patients underwent preoperatively spiral CT examination for assessing the degree of GBA invasion,and the consistency between spiral CT and pathological diagnosis was analyzed.Kaplan-Meier was adopted to analyze the postoperatively medium to long-term survival,and Cox proportional hazard model was used to analyze the influence factors that affected the short and long-term survival rate of patients with gastric carcinoma.Results:The accuracy of spiral CT was 80.77%in diagnosing the GBA invasion of PGC,and the Kappa value of that with the pathological results was 0.688(P<0.05).In the 3 years of follow-up after surgery,17 cases died and 61 cases survived in 78 patients.In the influence factors,the involvements of gastric diaphragmatic ligament,diaphragmatic muscle and perigastric fat were the main risk factors that affected the overall survival rate in the three years after surgery(Log rank=3.395,Log rank=6.373,Log rank=39.164,P<0.05).The univariate analysis indicated that the disease course,T clinical staging,the number of lymph nodes in GBA,the transmural involvement,the involvements of gastric diaphragmatic ligament and diaphragmatic muscle,and perigastric fat layer were the influence factors of affecting the overall survival rate of PGC patients in the three years after surgery(x^(2)=6.954,x^(2)=14.190,x^(2)=27.149,x^(2)=7.676,x^(2)=10.880,x^(2)=16.597,x^(2)=7.270,P<0.05).Cox regression analysis showed that the clinical staging,the transmural involvement,and the involvements of gastric diaphragmatic ligament,diaphragmatic muscle and perigastric fat layer were the independent influence factors for the overall survival rate of PGC patients in the three years after surgery(HR=1.286,HR=1.191,HR=1.072,HR=1.270,HR=1.046,P<0.05).Conclusion:CT signs of GBA violation in PGC patients can assess the postoperatively medium to long term survival of patients,and identify the high-risk patients with poor prognosis so as to adjust the treatment plan.