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目的:探讨进展期胃癌根治术后早期发生复发转移的影响因素,以及Ki-67表达与临床病理参数间相关性及对预后的影响。方法:回顾性分析2007-01-01-2011-08-31中国医科大学附属第四医院行根治术的128例胃癌患者临床资料,分为早期复发组(62例)和对照组(66例),进行临床病理参数比较,应用Cox模型分析独立影响因素。分析Ki-67与各临床病理参数关系,运用Kaplan-Meier法分析其与患者生存时间关系。结果:128例患者中,早期复发组与对照组肿瘤病理分级(χ2=11.170,P=0.004)、大体分型(χ2=7.049,P=0.008)、浆膜浸透(χ2=9.372,P=0.009)、淋巴结转移(χ2=16.516,P<0.001)、pTNM分期(χ2=40.911,P<0.001)、脉管癌栓(χ2=23.944,P<0.001)以及Ki-67表达(χ2=18.011,P<0.001)差异有统计学意义。Ki-67表达与肿瘤大小(χ2=10.383,P=0.016)、浸润深度(χ2=12.674,P=0.049)及淋巴结转移阳性率(P<0.001)存在明显相关性。单因素分析显示,肿瘤的病理分级(χ2=10.013,P=0.007)、浆膜浸润(χ2=11.632,P=0.003)、是否有淋巴结转移(χ2=14.197,P<0.001)、脉管癌栓(χ2=37.532,P<0.001)、pTNM分期(χ2=58.200,P<0.001)、大体分型(χ2=6.251,P=0.012)以及Ki-67表达(χ2=18.961,P<0.001)对肿瘤术后复发时间有影响。多因素分析显示,脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。随着淋巴结转移阳性率增加,其Ki-67的阳性表达率也增加,P<0.001;当Ki-67阳性表达>50%时,患者预后差。结论:脉管癌栓浸润、肿瘤pTNM分期和Ki-67表达是影响进展期胃癌根治术后早期复发及转移的独立危险因素。Ki-67对于判断胃癌肿瘤生物学行为有一定价值,可作为临床参考指标指导预后。
Objective: To investigate the influencing factors of early recurrence and metastasis of advanced gastric cancer after radical operation, and the correlation between Ki-67 expression and clinicopathological parameters and prognosis. Methods: A retrospective analysis of 128 patients with gastric cancer undergoing radical operation at the Fourth Affiliated Hospital of China Medical University from January 2007 to January 2011 was conducted. The data were divided into early recurrence group (62 cases) and control group (66 cases) , The clinical and pathological parameters were compared, the Cox model was used to analyze the independent influencing factors. The relationship between Ki-67 and clinicopathological parameters was analyzed. The Kaplan-Meier method was used to analyze the relationship between Ki-67 and patient's survival time. Results: Among the 128 patients, the pathological grade (χ2 = 11.170, P = 0.004), general type (χ2 = 7.049, P = 0.008) ), Lymph node metastasis (χ2 = 16.516, P <0.001), pTNM stage (χ2 = 40.911, P <0.001) <0.001) The difference was statistically significant. There was a significant correlation between Ki-67 expression and tumor size (χ2 = 10.383, P = 0.016), depth of invasion (χ2 = 12.674, P = 0.049) and lymph node metastasis (P <0.001). Univariate analysis showed that the pathological grade (χ2 = 10.013, P = 0.007), serosa invasion (χ2 = 11.632, P = 0.003), lymph node metastasis (χ2 = 14.197, P <0.001) (χ2 = 18.561, P <0.001), pTNM stage (χ2 = 58.200, P <0.001) Postoperative recurrence time has an impact. Multivariate analysis showed that vascular invasion, tumor pTNM stage and Ki-67 expression were the independent risk factors for the early recurrence and metastasis of advanced gastric cancer after radical operation. As the positive rate of lymph node metastasis increased, the positive expression rate of Ki-67 also increased, P <0.001; when Ki-67 positive expression> 50%, the prognosis of patients was poor. CONCLUSIONS: Invasion of vascular tumor thrombus, pTNM stage of tumor and expression of Ki-67 are independent risk factors for early recurrence and metastasis of advanced gastric cancer after radical operation. Ki-67 has certain value for judging the biological behavior of gastric cancer and can be used as a clinical reference to guide the prognosis.