Ⅲ期胃癌患者的长期预后和复发危险因素

Long-term survival and recurrence risk factors of patients with stageⅢgastric cancer after radical gastrectomy and adjuvant chemotherapy

目的分析Ⅲ期胃癌患者在根治术联合辅助化疗后的长期预后及复发危险因素。方法回顾性分析2006至2011年间在中国医学科学院肿瘤医院接受胃癌根治术和奥沙利铂+氟尿嘧啶类药物±多西他赛辅助化疗的Ⅲ期胃癌患者的临床病理资料和预后。结果本研究共纳入324例胃癌患者,中位随访时间108个月,175例(54%)患者胃癌复发。183例(56.5%)患者死亡,其中169例(52.2%)死于胃癌复发。全部患者中位无病生存期35个月,中位总生存期64个月。ⅢA、ⅢB和ⅢC期患者的5年生存率分别为58.2%、51.5%和25.6%(P<0.01)。多因素分析显示T4b期(P=0.02)、高淋巴结转移率(P<0.01)和神经侵犯(P=0.01)是独立不良预后因素,辅助化疗时长超过12周则可改善生存(P=0.001)。高淋巴结转移率者更容易发生腹膜转移(P=0.038)以及区域淋巴结转移(P<0.01)和远处淋巴结转移(P<0.01),神经侵犯者更容易发生腹膜转移(P=0.047),化疗时长超过12周可降低血行转移风险(P=0.023)。结论Ⅲ期胃癌患者各亚组的预后差异显著。高淋巴结转移率和神经侵犯与不良预后和不同的复发类型有关。

Objective To explore long-term outcome and risk factors of recurrence in stageⅢgastric cancer patients who underwent radical gastrectomy and adjuvant chemotherapy.Methods The clinical and pathological data of patients with stageⅢ(AJCC V8)gastric adenocarcinoma were analyzed retrospectively.All patients received radical gastrectomy and adjuvant chemotherapy consisting of oxaliplatin,fluoropyrimidines with or without docetaxel in our center during 2006 and 2011.Results A total of 324 patients were enrolled into the study.With a median follow-up time of 108 months,175(54%)patients developed tumor recurrence.One hundred and eighty-three(56.5%)patients died,including 169(52.2%)dying of gastric cancer recurrence.The median disease-free survival(DFS)was 35 months,and the median overall survival(OS)was 64 months.The 5-year OS rates were 58.2%,51.5%and 25.6%in patients with stageⅢA,ⅢB andⅢC diseases,respectively(P<0.01).Multivariate analysis revealed that T4b cancers(P=0.02),higher lymph meta node ratio(LNR)(P<0.01)and perineural invasion(P=0.01)were independent negative prognostic factors,while more than 12 weeks of adjuvant chemotherapy may improve survival.Higher LNR was correlated with locoregional(P<0.01),distant lymph node metastases(P<0.01),and peritoneal metastases(P=0.038).Perineural invasion(P=0.047)was prone to peritoneal metastases.More than 12 weeks of adjuvant chemotherapy could reduce the risk of haematogenous metastases(P=0.023).Conclusions Outcomes were significantly different in subgroups of patients with stageⅢgastric cancers after radical gastrectomy.Higher LNR and perineural invasion could predict poor prognosis and different recurrence patterns.