胃癌D2根治术后复发时间及相关因素分析
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摘要
目的探讨胃癌D2根治术后早期复发时间及相关影响因素,为预防胃癌早期复发提供参考依据。方法回顾性分析我院胃癌D2根治术后在2012年1月~2016年1月复发的178例患者临床病例资料,按复发时间分为早期复发(≤2年)组119例和晚期复发(>2年)组59例,对比两组患者在不同复发时间下的一般情况、临床病理等资料,采用SPSS19.0软件对数据进行单因素及多因素分析。结果早期复发组平均无病生存期为(11.72±5.85)个月,晚期复发组平均无病生存期为(31.00±7.65)个月;单因素分析结果显示两组在年龄、手术类型、原发肿瘤直径、肿瘤Borrmann分型、原发组织分化、原发T分期、原发N分期、受检淋巴结个数、原发淋巴结转移率、原发手术切缘、原发脉管有无癌栓、有无癌结节、术后至第一次化疗时间、术后有无4~6周铂类联合氟尿嘧啶化疗、复发形式及无病生存期方面,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析表明,手术类型、受检淋巴结个数、原发脉管有无癌栓、N分期及术后至第一次化疗时间是胃癌复发的独立相关影响因素(P<0.05)。结论手术类型、受检淋巴结个数及术后至第一次化疗时间是影响胃癌D2根治术后复发时间的独立保护因素。N分期及脉管有癌栓是胃癌D2根治术的独立危险因素。
Objective To investigate the time of early recurrence after D2 radical resection of gastric cancer and its related factors,and to provide reference for prevention of early recurrence of gastric cancer. Methods The clinical data of 178 cases of gastric cancer relapsing from January 2012 to January 2016 after D2 radical operation in our hospital were retrospectively analyzed.According to the time of recurrence,119 cases of early recurrence group(≤2 years)and 59 cases of late recurrence group(>2 years)were divided into two groups:comparing the general situation and clinicopathological data of the two groups in the different time of recurrence,the data were analyzed with SPSS19.0 software for single factor and multi factor analysis. Results The average disease-free survival time was(11.72±5.85)months in the early relapse group and(31.00 ±7.65)months in the late relapse group.Univariate analysis showed that the two groups were in age,type of surgery,primary tumor diameter,tumor Borrmann type, primary tissue differentiation,primary T stage,primary N stage,number of lymph nodes examined,primary lymph node metastasis rate, primary surgical margin,primary vessel thrombosis,presence of no difference in tumor nodules,postoperative to first chemotherapy time, and postoperative 4 to 6 weeks platinum-based fluorouracil chemotherapy,relapsed forms and disease-free survival were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the type of operation,the number of lymph nodes under examination,the presence or absence of tumor thrombosis in the primary vasculature,N-stage staging,and postoperative to first chemotherapy time were independent and influential factors for gastric cancer recurrence(P<0.05).Conclusion The type of operation, the number of lymph nodes examined,and the time from the first operation to the first time of chemotherapy are independent protective factors influencing the recurrence time of gastric cancer after D2 radical resection.N staging and vascular tumor thrombosis were independent risk factors for D2 radical gastrectomy.
Objective To investigate the time of early recurrence after D2 radical resection of gastric cancer and its related factors,and to provide reference for prevention of early recurrence of gastric cancer. Methods The clinical data of 178 cases of gastric cancer relapsing from January 2012 to January 2016 after D2 radical operation in our hospital were retrospectively analyzed.According to the time of recurrence,119 cases of early recurrence group(≤2 years)and 59 cases of late recurrence group(>2 years)were divided into two groups:comparing the general situation and clinicopathological data of the two groups in the different time of recurrence,the data were analyzed with SPSS19.0 software for single factor and multi factor analysis. Results The average disease-free survival time was(11.72±5.85)months in the early relapse group and(31.00 ±7.65)months in the late relapse group.Univariate analysis showed that the two groups were in age,type of surgery,primary tumor diameter,tumor Borrmann type, primary tissue differentiation,primary T stage,primary N stage,number of lymph nodes examined,primary lymph node metastasis rate, primary surgical margin,primary vessel thrombosis,presence of no difference in tumor nodules,postoperative to first chemotherapy time, and postoperative 4 to 6 weeks platinum-based fluorouracil chemotherapy,relapsed forms and disease-free survival were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the type of operation,the number of lymph nodes under examination,the presence or absence of tumor thrombosis in the primary vasculature,N-stage staging,and postoperative to first chemotherapy time were independent and influential factors for gastric cancer recurrence(P<0.05).Conclusion The type of operation, the number of lymph nodes examined,and the time from the first operation to the first time of chemotherapy are independent protective factors influencing the recurrence time of gastric cancer after D2 radical resection.N staging and vascular tumor thrombosis were independent risk factors for D2 radical gastrectomy.
引文
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[12]孙凤永,李继福,韩春伟.胃癌根治术后患者预后的影响因素分析[J].中华临床医师杂志(电子版),2016(7):139-140.
[13]彭朝龙,贺卫东.1062例胃癌淋巴结转移相关因素分析[J].医师进修杂志,2003,26(02):35-36.
[14]郑南翔,单廷.胃癌根治术患者术后早期复发转移的相关危险因素[J].中国老年学杂志,2017,37(17):4301-4303.
[15]Kattan MW,Karpeh MS,Mazumdar M,et al.Postoperative nomogram for disease-specific survival after an R0 resection for gastric cancer:data from a large US-population database[J].Clin Oncol,2005,23:7114-7124.
[16]程元光,文刚,涂从银,等.胃癌第8p淋巴结转移的相关因素分析[J].安徽医药,2014,18(05):855-858.
[17]Ohe H,Lee WY,Hong SW,et al.Prognostic value of the distance of proximal resection margin in patients who have undergone curative gastric cancer surgery[J].World J Surg Oncol,2014,12(1):296.
[18]施伟,王建,张梅玲,等.1340例胃癌根治术后患者预后的多因素分析[J].南京医科大学学报(自然科学版),2011,31(09):1310-1315.
[2]Siegel R,Naishadham D,Jemal A.Cancer statistics,2013[J].CA Cancer J Clin,2013,63(1):11-30.
[3]胡祥.日本《胃癌治疗指南》(第3版)解读[J].中国实用外科杂志,2010,30(01):25-30.
[4]王振,李卫东,朱理玮.71例胃癌根治术后复发类型及相关因素分析[J].天津医科大学学报,2012,18(01):93-96.
[5]秦尚学.Ⅲ期和Ⅳ期胃癌根治术后早期复发的危险因素分析[J].中国现代普通外科进展,2013,16(01):36-38,55.
[6]张卫宁,线胤生,任磊鹏.全胃切除术治疗进展期胃癌56例临床分析[J].陕西医学杂志,2013,42(08):1051-1052.
[7]Garancinil M,Uggeri F,Degrate L,et al.Surgical treatment of liver metastases of gastric cancer is local treatment in a systemic disease worthwhile[J].HPB(Oxford),2012,14(3):209-215.
[8]Baiocchi GL,Marrelli D,Verlato G,et al.Follow-up after gastrectomy for cancer:an appraisal of the Italian research group for gastric cancer[J].Ann Surg Oncol,2014,21(6):2005-2011.
[9]陈永明,李元方,詹友庆,等.胃癌根治术后复发转移的规律[J].广东医学,2012,33(17):2579-2582.
[10]赵丹,龚光伟,李胜文,等.胃癌根治术后复发类型及影响因素分析[J].实用癌症杂志,2013,28(03):278-281.
[11]陈维平,谢芸.胃癌患者手术治疗的预后及其影响因素分析[J].牡丹江医学院学报,2016,37(03):42-43,26.
[12]孙凤永,李继福,韩春伟.胃癌根治术后患者预后的影响因素分析[J].中华临床医师杂志(电子版),2016(7):139-140.
[13]彭朝龙,贺卫东.1062例胃癌淋巴结转移相关因素分析[J].医师进修杂志,2003,26(02):35-36.
[14]郑南翔,单廷.胃癌根治术患者术后早期复发转移的相关危险因素[J].中国老年学杂志,2017,37(17):4301-4303.
[15]Kattan MW,Karpeh MS,Mazumdar M,et al.Postoperative nomogram for disease-specific survival after an R0 resection for gastric cancer:data from a large US-population database[J].Clin Oncol,2005,23:7114-7124.
[16]程元光,文刚,涂从银,等.胃癌第8p淋巴结转移的相关因素分析[J].安徽医药,2014,18(05):855-858.
[17]Ohe H,Lee WY,Hong SW,et al.Prognostic value of the distance of proximal resection margin in patients who have undergone curative gastric cancer surgery[J].World J Surg Oncol,2014,12(1):296.
[18]施伟,王建,张梅玲,等.1340例胃癌根治术后患者预后的多因素分析[J].南京医科大学学报(自然科学版),2011,31(09):1310-1315.