影响胃癌术后复发及预后的相关因素分析

Evaluation of factors related to prognosis and postoperative recurrence of gastric cancer

摘要:

目的:探讨胃癌术后复发的时间规律以及远期预后评估指标。 方法:将25年间经笔者所在医院科室诊治的胃癌术后复发的447例患者按照复发间隔期（第1次手术至复发的时间）的长短分为2组：A组为术后<2年复发， B组为术后2~5年复发。用KaplanMeier法计算两组术后生存率，以Cox模型进行多变量分析。 结果:胃癌术后复发的患者占同期胃癌手术患者的29.3%（447/1 526），其中312例（69.8%)于2年内复发(A组)，135例（30.2%）于2~5年内的复发(B组)。单因素分析显示，无病生存期、病灶部位、肿瘤大体类型、病理分型、肿瘤分期、手术性质以及复发类型(局部，远处)等因素对胃癌术后复发患者的累计生存率有显著影响（均P<0.05），其中病灶在胃底、Borrmann Ⅲ型、黏液腺癌、手术方式为D0、肿瘤TNM分期为Ⅳ期的患者2年内复发的构成比较其他患者明显高，在2年内复发的患者中局部复发所占的比例相对较大。多因素分析显示无病生存期、肿瘤分期和肿瘤大体类型是胃癌术后复发患者的累计生存率的独立影响因素。无病生存期和无进展生存期均与术后复发患者的生存期呈正相关。 结论:胃癌术后复查至少应持续5年，前2年每3个月复查1次，之后每3~6个月复查1次，无病生存期和无病进展生存期可作为胃癌复发患者远期治愈和预后的最佳预测指标。

Abstract:

Abstract:Objective:To investigate the regular patterns of postoperative recurrence of gastric cancer and evaluate  the indicators of longterm prognosis.
Methods:A total of 447 patients who underwent gastric cancer operation over a period of 25 years and had recurrece were divided into 2 groups: <2 years and 2-5 years, in accordance with the interval time of recurrence after the primary surgery . Survival rate was calculated by the KaplanMeier method and multivariate analysis was recorded by Cox. Model.
Results:The postoperative recurrence rate of gastric cancer was 29.3% (447/1526), of which the 2 year recurrence was 69.8% (312/447), and 2-5 years recurrence  accounted for 30.2% (135/447). Singlefactor analysis showed that cumulative survival was significantly affected by tumor location,  gross tumor type, pathological type, tumor stage, type of surgery, as well as the location (local or distant) of recurrence. Multifactor analysis showed that tumor stage and gross characteristics of cancer were the independent factors of cumulative survival rate. Diseasefree survival and diseasefree progressionfree survival were positively related to the survival period of patients.
Conclusions:Patients with gastric cancer should be followedup  for at least  five years; in the first two years, they should be examined every 3 months, and in the later 2-5 years, they should be examined every 6 months. A diseasefree survival and diseasefree progressionfree survival can be used as indicatois of  longterm cure and the best predictor of prognosis.