进展期远端胃癌根治术后腹膜转移危险因素和预后分析

Risk factors and prognosis analysis of peritoneal metastasis after radical gastrectomy for advanced distal gastric cancer

目的探讨局部进展期远端胃癌根治术后发生腹膜转移的危险因素和预后。方法回顾性分析2009年1月1日至2015年12月31日在中山大学附属第一医院胃肠外科中心接受根治性手术的353例进展期远端胃腺癌(pT3~4NxM0和pTxN1~3M0)的病例资料,根据术后是否发生腹膜转移分为腹膜转移组(139例)和无腹膜转移组(214例)。收集研究病例的围手术期数据,采用多因素Logistic回归模型分析影响根治性手术后腹膜转移的危险因素,同时比较两组的围手术期资料和长期预后的差异。结果单因素分析结果发现腹膜转移组的pT分期、pN分期、pTNM分期均比无腹膜转移组更晚期(均P<0.001),腹膜转移组肿瘤直径更大(P=0.043),术前糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)水平更高(P=0.035)。多因素Logistic回归分析发现pT分期(P<0.001)和pN分期(P=0.007)是影响根治术后腹膜转移的独立危险因素。与腹膜转移组相比,无腹膜转移组实施淋巴结脉络化清扫的比例更高(55.1%比43.9%,P=0.039),输血量更低(P=0.026)。两组在手术时间、术中出血量、获检淋巴结数目、术后住院时间的差异无统计学意义(P>0.05)。与无腹膜转移组比较,腹膜转移组在No.1、No.3、No.4、No.6、No.7、No.8、No.9组淋巴结的转移率更高(均P<0.05)。本研究中所有病例中位随访时间65.0个月。无腹膜转移组3年无疾病进展生存率(92.5%比13.9%,P<0.001)和5年总生存率(92.9%比10.2%,P<0.001)高于腹膜转移组。结论pT分期和pN分期是影响进展期远端胃癌根治术后腹膜转移的独立危险因素,腹膜转移患者预后差。

This study explores the risk factors and prognosis of peritoneal metastasis in patients with locally advanced distal gastric cancer after radical surgery.Method The data of 353 cases of advanced distal gastric adenocarcinoma(pT3-4NxM0 and pTxN1-3M0)who underwent radical surgery at the Gastrointestinal Surgery Center of the First Affiliated Hospital of Sun Yat-sen University from January 1,2009 to December 31,2015 were retrospectively analyzed.According to whether peritoneal metastasis occurred after surgery,they were divided into peritoneal metastasis group(139cases)andnonperitonealmetastasis group(214 cases).This study collected perioperative data from included cases and used multivariate Logistic regression model to analyze the risk factors affecting peritoneal metastasis after radical surgery,while comparing the differences in perioperative data and long-term prognosis between the two groups.Result The results of univariate analysis showed that the pT stage,pN stage,and pTNM stage in the peritoneal metastasis group were all later than those in the non peritoneal metastasis group(all P<0.001).The peritoneal metastasis group had a larger tumor diameter(P=0.043)and preoperative carbohydrate antigen 19-9(CA19-9)levels were higher(P=0.035).Multivariate Logistic regression analysis revealed that pT staging(P<0.001)and pN staging(P=0.007)were independent risk factors for peritoneal metastasis after radical surgery.Compared with the peritoneal metastasis group,the non peritoneal metastasis group had a higher proportion of lymph node revascularization dissection(55.1%vs.43.9%,P=0.039)and a lower blood transfusion volume(P=0.026).There were no statistically significant differences between the two groups in terms of surgical time,intraoperative bleeding volume,number of detected lymph nodes,and postoperative hospital stay(all P>0.05).The peritoneal metastasis group had a higher lymph node metastasis rate in No.1,No.3,No.4,No.6,No.7,No.8,and No.9 groups(all P<0.05).The median follow-up time for all cases in this study was 65.0 months.The 3-year progression-free survival rate(92.5%vs.13.9%,P<0.001)and 5-year overall survival rate(92.9%vs.10.2%,P<0.001)of the non peritoneal metastasis group were higher than those of the peritoneal metastasis group.Conclusion pT staging and pN staging are independent risk factors for peritoneal metastasis after radical resection of advanced distal gastric cancer,and patients with peritoneal metastasis have a poor prognosis.