进展期胃癌术后生存相关影响因素分析

陈梦雅; 邓敏; 郑海伦; 邓晓晶

doi:10.13898/j.cnki.issn.1000-2200.2024.03.008

进展期胃癌术后生存相关影响因素分析

Analysis of influencing factors related to postoperative survival in progressive gastric cancer

摘要

摘要:
目的探讨进展期胃癌外科手术后生存预后的影响因素。
方法采用回顾性病例系列研究方法，纳入577例行胃癌根治术的cⅡ~ⅣA期胃癌病人。分析临床特征、手术方式、病理特征、辅助化疗等对病人术后无疾病生存期(DFS)和总体生存期(OS)的影响。
结果 577例进展期胃癌病例的中位DFS为48个月，中位OS为53个月，病例中出现转移及复发294例，死亡302例，275例存活。Kaplan-Meier生存分析显示，年龄、肿瘤部位、肿瘤直径、Borrmann分型、分化程度、淋巴结转移、神经脉管侵犯、浸润深度、临床分期、是否化疗、化疗周期、人表皮生长因子2(HER2)是否阳性、Ki-67是否阳性是胃癌预后的相关因素，与胃癌的DFS及OS相关(P < 0.05~P < 0.01)。Cox回归比例风险模型分析显示，Borrmann分型、淋巴结转移、浸润深度、化疗周期、HER2及Ki-67是DFS的独立预后因素(P < 0.05~P < 0.01)，Borrmann分型、淋巴结转移、浸润深度、化疗周期、HER2是OS的独立预后因素(P < 0.05~P < 0.01)。HER2阳性、Ki-67阳性的复发危险分别为阴性的1.868倍、1.665倍，HER2阳性的死亡危险是阴性的1.832倍。
结论手术方式、病理特征及辅助化疗对进展期胃癌DFS及OS均有影响。

Abstract:
Objective To explore the influencing factors related to survival prognosis after surgery for progressive gastric cancer.
Methods A retrospective case series study was conducted, and 577 stage cⅡ-ⅣA gastric cancer patients undergoing radical gastrectomy were selected.The influence of clinical characteristic, surgical method, pathological feature, adjuvant chemotherapy, etc.on postoperative disease-free survival (DFS) and overall survival (OS) of patients was analyzed.
Results The the median DFS of 577 cases with progressive gastric cancer was 48 months, and the median OS was 53 months.Among the patients, 294 cases experienced metastasis and recurrence, 302 cases died, and 275 survived.Kaplan-Meier survival analysis showed that age, tumor site, tumor size, Borrmann classification, differentiation degree, lymph node metastasis, neurovascular invasion, infiltration depth, clinical stage, chemotherapy or not, chemotherapy cycle, positive human epidermal growth factor 2 (HER2) expression or not, and positive Ki-67 expression or not were related factors for the prognosis of gastric cancer, which were correlated with DFS and OS of gastric cancer (P < 0.05 to P < 0.01).Cox proportional hazards regression model analysis showed that Borrmann classification, lymph node metastasis, infiltration depth, chemotherapy cycle, HER2, and Ki-67 were independent prognostic factors for DFS (P < 0.05 to P < 0.01), while Borrmann classification, lymph node metastasis, infiltration depth, chemotherapy cycle, and HER2 were independent prognostic factors for OS (P < 0.05 to P < 0.01).The recurrence risk of positive HER2 and Ki-67 expression was 1.868 times and 1.665 times higher than that of negative HER2 and Ki-67 expression, respectively, and the death risk of positive HER2 expression was 1.832 times higher than that of negative HER2 expression.
Conclusions Surgical method, pathological feature and adjuvant chemotherapy have impacts on DFS and OS in progressive gastric cancer.

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