中晚期胃癌预后影响因素分析

Analysis of Prognostic Risk Factors in Advanced Gastric Cancer

目的筛选影响中晚期胃癌预后的危险因素,为中晚期胃癌的预防和干预提供依据。方法以河南省郑州市4所医院(河南省中医药研究院、河南中医药大学第二附属医院、河南中医药大学第三附属医院、河南省肿瘤医院)2014—2020年收治的中晚期胃癌住院患者为研究对象,收集住院患者病历信息和随访数据资料,采用RWS模式进行回顾性队列研究。收集资料内容包括一般资料、病情病史特征、实验室指标、病理类型及分化程度、转移情况、中医证候等信息以及死亡事件发生情况。以随访过程中“患者死亡”为结局因变量,同时,以从研究对象进入队列到出现死亡重点事件的时间为时间因变量,应用COX比例风险回归模型进行中晚期胃癌预后危险因素的分析。结果该研究最终纳入了538例患者,发生死亡终点事件组293例,未发生组245例,队列随访累积观察时间为1590人年,中晚期胃癌病死率为18.428/100人年(95%CI:15.678/100人年~21.177/100人年)。多因素COX回归分析显示,分化程度和远处转移为危险因素,其中分化程度使中晚期终点事件风险增加0.44倍(HR=1.44,95%CI:1.13~1.84),远处转移可使中晚期胃癌终点事件的风险增加0.60倍(HR=1.60,95%CI:1.26~2.04);中药为保护因素,中药可降低中晚期胃癌终点事件的风险0.3倍(HR=0.7,95%CI:0.51~0.96)。结论该研究发现远处转移、分化程度为中晚期胃癌独立危险因素,中药是保护因素,临床上应针对危险因素加强中晚期胃癌病人死亡风险的预防和干预。

Objective To screen the risk factors affecting the prognosis of middle-advanced gastric cancer and provide basis for the prevention and intervention of middle-advanced gastric cancer.Methods The patients with advanced gastric cancer who were admitted to 4 hospitals in Zhengzhou City,Henan Province(Henan Institute of Traditional Chinese Medicine,The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine,The Third Affiliated Hospital of Henan University of Traditional Chinese Medicine nd Henan Cancer Hospital)from 2014 to 2020 were selected.The patients were the subjects of the study,and the medical records and follow-up data of hospitalized patients were collected,and a retrospective cohort study was conducted using the RWS model.The collected data included general information,characteristics of disease history,laboratory indicators,pathological type and degree of differentiation,metastasis,TCM syndromes and other information,as well as the occurrence of death events.Taking“patient death”as the outcome dependent variable during the follow-up process,and at the same time,the time from the study subjects entering the cohort to the occurrence of the key event of death as the time dependent variable,the COX proportional hazards regression model was used to analyze the prognostic risk factors of advanced gastric cancer.Results A total of 538 patients were finally included in this study,293 in the death endpoint event group and 245 in the non-occurring group.The cumulative observation time of the cohort follow-up was 1590 person-years,and the mortality rate of advanced gastric cancer was 18.428/100 person-years(95%CI:15.678/100 person-years-21.177/100 person-years).Multivariate COX regression analysis showed that the degree of differentiation and distant metastasis were risk factors,and the degree of differentiation increased the risk of intermediate and advanced endpoint events by 0.44 times(HR=1.44,95%CI:1.13~1.84).The risk of gastric cancer endpoint events increased by 0.60 times(HR=1.60,95%CI:1.26~2.04);traditional Chinese medicine was a protective factor,and traditional Chinese medicine could reduce the risk of advanced gastric cancer endpoint events by 0.3 times(HR=0.7,95%CI:0.51~0.96).Conclusion This study has found that distant metastasis and degree of differentiation are independent risk factors for advanced gastric cancer,and traditional Chinese medicine is a protective factor.Clinically,the prevention and intervention of mortality risk in patients with advanced gastric cancer should be strengthened according to the risk factors.