可切除胃癌伴脉管癌栓患者预后影响因素分析

Analysis of prognostic factors in patients with resectable gastric cancer with vascular cancer thrombus

目的探索可切除胃腺癌伴脉管癌栓(RGAVCT)患者预后的影响因素,并建立相关列线图预后模型。方法回顾性收集2017年1月至2022年1月山西医科大学附属肿瘤医院530例胃腺癌合并脉管癌栓行胃癌根治性切除术患者的临床病理资料,按7∶3的比例随机分配到训练队列和验证队列。采用Kaplan-Meier曲线及Log-rank检验和多因素Cox回归分析训练队列患者死亡的风险因素,构建RGAVCT患者1年、2年、4年生存概率的列线图模型。利用ROC曲线分析列线图模型在训练队列和验证队列患者中的应用效能。结果训练队列患者年龄、术后化疗、肿瘤大小、Ki67表达情况、T分期、N分期以及临床分期是RGAVCT患者生存期(OS)的影响因素(P<0.05);术后化疗(P<0.001,HR=0.302,95%CI:0.219-0.418),T分期[T3(P=0.015,HR=11.782,95%CI:1.628-85.283)、T4a+4b(P=0.005,HR=17.219,95%CI:2.343-126.559)]、N分期[N2(P=0.309,HR=1.310,95%CI:0.779-2.201)N3a(P=0.001,HR=2.268,95%CI:1.407-3.657)、N3b(P<0.001,HR=2.836,95%CI:1.708-4.709)]是RGAVCT患者OS的独立影响因素。采用Cox回归结果建立预测患者术后1年、2年、4年生存概率的列线图模型。训练队列AUROC面积和C指数均>0.7,验证队列的AUROC面积和C指数均>0.67。结论本研究建立了RGAVCT患者的术后1年、2年、4年生存概率的列线图模型,可以较好地预测RGAVCT患者的术后生存状况。

Objective To explore the factors influencing the prognosis of patients with Resectable gastric adenocarcinoma with vascular cancer thrombus(RGAVCT)and to develop a relevant columnar graphic prognostic model.Methods Clinicopathologic data of 530 patients with gastric adenocarcinoma combined with vascular cancer embolization who underwent radical gastrectomy for gastric cancer at the Affiliated Cancer Hospital of Shanxi Medical University were retrospectively collected from January 2017 to January 2022,and were randomly assigned to the training cohort and the validation cohort in a 7∶3 ratio.Kaplan-Meier curves and Log-rank test and multifactorial Cox regression were used to analyze the risk factors for death in the training cohort patients,and to construct Nomogram Model for the probability of survival at 1,2,and 4 years in RGAVCT patients.ROC curves were used to analyze the efficacy of the Nomogram model in the training cohort and validation cohort patients.Results Age,postoperative chemotherapy,tumor size,Ki67 expression status,T-stage,N-stage,and clinical stage of patients in the training cohort were the influencing factors on survival(OS)of patients with RGAVCT(P<0.05);postoperative chemotherapy(P<0.001,HR=0.302,95%CI:0.219-0.418),T-stage[T3(P=0.015,HR=11.782,95%CI:1.628-85.283),T4a+4b(P=0.005,HR=17.219,95%CI:2.343-126.559)],N staging[N2(P=0.309,HR=1.310,95%CI:0.779-2.201)N3a(P=0.001,HR=2.268,95%CI:1.407-3.657),N3b(P<0.001,HR=2.836,95%CI:1.708-4.709)]were independent influences on OS in patients with RGAVCT.Cox regression results were used to develop nomogram models for predicting the probability of patients′survival at 1,2,and 4 years after surgery.The AUROC area and C index were>0.7 for the training cohort and>0.67 for the validation cohort.Conclusion In this study,we developed a nomogram model of 1-,2-,and 4-year postoperative survival probabilities of RGAVCT patients,which can better predict the postoperative survival of RGAVCT patients.