癌结节对根治切除术后胃癌患者预后的影响

Tumor deposit is an independent prognostic factor in patients with gastric cancer after radical gastrectomy

目的探究癌结节对根治切除术后胃癌患者预后的影响。方法回顾性分析于2021年1月至2023年12月在北京大学人民医院胃肠外科行根治性手术的212例胃癌患者,评估胃癌患者癌结节状态与临床病理特征的关系以及对胃癌患者术后总生存期的影响。结果212例胃癌患者中12例(5.1%)患者病理检查提示有癌结节。癌结节的发生与术前T分期、N分期、壁外血管侵犯均有关(均P<0.05)。随访期间内31例患者发生复发、转移或死亡,COX多因素分析结果提示N分期(P=0.07)、术前血清CEA水平(P<0.001)、壁外血管侵犯(P=0.001)、癌结节(P=0.011)均是影响患者术后总生存时间的独立危险因素。在术前行新辅助治疗、pT4期、pN+及有壁外血管侵犯的患者中,癌结节的状态与总生存率密切相关,有癌结节的患者预后更差,生存期更短,差异有统计学意义(P<0.05)。结论癌结节是影响根治性胃癌患者预后的重要危险因素。

Objective To investigate the effect of tumor deposit(TD)on the prognosis of patients with gastric cancer after radical surgery.Methods A retrospective analysis was performed on gastric cancer patients who underwent radical surgery at the Department of Gastrointestinal Surgery,Peking University People's Hospital from Jan 2021 to Dec 2023.The relationship between the status of tumor deposit and clinicopathological features,as well as the impact on the overall postoperative survival of gastric cancer patients were evaluated.Results Pathological examination revealed that among 212 patients with gastric cancer,12 patients(5.1%)had tumor deposits(TD).The occurrence of TD was found to be associated with preoperative T stage,N stage,and extramural vascular invasion(EMVI)(all P<0.05).During the follow-up period,31 patients experienced recurrence,metastasis,or death.The COX multivariate analysis indicated that N stage(P=0.07),preoperative serum CEA level(P<0.001),EMVI(P=0.001),and TD(P=0.011)were independent risk factors affecting the overall postoperative survival.Among patients who received neoadjuvant therapy and on pT4 stage,pN+status,and EMVI status before surgery,the presence of TD was closely correlated with overall survival.Patients with TD had a worse prognosis and shorter overall survival(P<0.05).Conclusion Tumor deposit is an important risk factor affecting the prognosis of patients after radical gastrectomy and may be a predictive biomarker of early peritoneal metastasis.