374例根治术后肠型胃癌患者预后的影响因素分析

  目的  肠型胃癌约占中国胃癌总数的40%～45%，本研究旨在探讨根治术后肠型胃癌预后的影响因素。  方法  回顾性收集2010年7月至2015年7月于山东第一医科大学附属省立医院行根治性切除且术后病理证实为肠型胃癌患者的临床病理和预后资料。Log-rank检验比较各临床病理特征对无病生存期（disease-free survival, DFS）和总生存期（overall survival, OS）的影响。单因素分析中P<0.1的因素纳入Cox多因素回归分析。  结果  共纳入374例患者，5年DFS率为73.4%，5年OS率为79.7%。单因素分析显示>60岁、组织学中分化、肿瘤直径>3 cm、T3～4期、淋巴结浸润、TNM分期晚、非远端胃癌、脉管癌栓、神经侵犯、人表皮生长因子受体-2（human epidermal growth factor receptor-2, HER-2）过表达和高血小板-淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）与DFS和OS不佳显著相关（P<0.05）。多因素分析显示年龄、神经侵犯和TNM分期为DFS和OS的独立预后因素。  结论  年龄>60岁、组织学中分化、肿瘤直径>3 cm、TNM分期晚、非远端胃癌、脉管癌栓、神经侵犯、HER-2过表达和高PLR是根治术后肠型胃癌预后不良的危险因素。年龄、神经侵犯和TNM分期是根治术后肠型胃癌预后的独立预测因素。 

Prognostic analysis of 374 patients with intestinal-type gastric cancer after radical resection

  Objective  In China, intestinal-type gastric cancer accounts for 40%?45% of gastric cancers. This study aimed to evaluate the prognostic factors of patients with intestinal-type gastric cancer after radical resection.  Methods  The clinicopathological and prognostic data of patients, who underwent radical resection and were pathologically diagnosed with primary intestinal-type gastric cancer between July 2010 and July 2015 in Shandong Provincial Hospital Affiliated to Shandong First Medical University, were retrospectively collected. Log-rank tests were used to compare the effects of clinicopathological features on disease-free survival (DFS) and overall survival (OS). Factors with P values < 0.10 in univariate analysis were included in multivariate Cox regression analysis.  Results  In total, 374 patients were enrolled. The 5-year DFS rate was 73.4%, and the 5-year OS rate was 79.7%. Univariate analysis showed that age > 60 years, moderate histological differentiation, primary tumor diameter > 3 cm, T3?4 stage, lymph node invasion, advanced tumor-node-metastasis (TNM) stage, non-distal gastric cancer, lymphovascular invasion, neural invasion, human epidermal growth factor receptor-2 (HER-2) overexpression, and a high platelet-to-lymphocyte ratio (PLR) were poor prognostic factors (P < 0.05). Multivariate analysis indicated that age, neural invasion and TNM stage were independently associated with poor prognosis.  Conclusions  Age > 60 years, moderate histological differentiation, primary tumor diameter > 3 cm, advanced TNM stage, non-distal gastric cancer, lymphovascular invasion, neural invasion, HER-2 overexpression, and a high PLR are the risk factors of poor prognosis in patients with intestinal-type gastric cancer after radical resection. Age, neural invasion and TNM stage are independent predictors of poor prognosis in patients with intestinal-type gastric cancer after radical resection.