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目的:探讨胃癌根治术后放化疗后肿瘤局部复发及远处转移模式及预后因素。方法:回顾性分析2004-2014年143例胃癌根治术后在我院行化疗及序贯放化疗后复发转移患者,对其首次失败部位、预后影响因素进行分析。结果:143例术后失败中局部复发93例,最常见部位分别为腹膜后淋巴结、瘤床、吻合口,其中腹膜后淋巴结转移多为第16组淋巴结A2、B1站,远处转移共89例,以腹腔种植、肝脏、肺较常见。术后放疗组中局部复发概率明显小于术后化疗组,远处转移概率无明显区别。单因素分析显示肿瘤TNM分期、分化程度、手术方式、淋巴结阳性率、浸润深度为影响胃癌术后无进展生存期的因素(P<0.05)。结论:胃癌术后患者应强调规范化的综合治疗以减少复发及转移,其失败模式主要以腹膜后淋巴结转移及腹腔种植转移为主,辅助性放疗可明显减少局部复发概率。
Objective: To investigate the local recurrence and distant metastasis patterns and prognostic factors of tumor after radiotherapy and chemotherapy in patients with gastric cancer. Methods: A total of 143 patients with gastric cancer who undergone chemotherapy and sequential radiotherapy and chemotherapy in our hospital from 2004 to 2014 were retrospectively analyzed. The first failure site and prognostic factors were analyzed. Results: Of the 143 cases, 93 cases had local recurrence after operation. The most common sites were retroperitoneal lymph node, tumor bed and anastomosis. Among them, the majority of retroperitoneal lymph node metastasis was group A2 lymph node A2, B1, and distant metastasis 89 , To abdominal cultivation, liver, lung more common. The local recurrence probability in postoperative radiotherapy group was significantly less than that in postoperative chemotherapy group, and the distant metastasis probability was not significantly different. Univariate analysis showed that TNM staging, differentiation degree, operation method, lymph node positive rate and depth of invasion were the factors affecting the progression-free survival of gastric cancer (P <0.05). Conclusion: Postoperative patients with gastric cancer should emphasize standardized comprehensive treatment to reduce the recurrence and metastasis. The failure mode is mainly based on retroperitoneal lymph node metastasis and peritoneal metastasis. Adjuvant radiotherapy can significantly reduce the local recurrence probability.