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目的探讨不同病理类型进展期胃癌患者的临床病理特征及预后因素。方法回顾性分析2011年间在南京大学医学院附属鼓楼医院集团宿迁市人民医院行胃癌根治术的98例进展期胃癌患者的临床病理资料,其中胃腺癌53例,胃黏液腺癌30例,胃印戒细胞癌15例,比较不同病理类型进展期胃癌患者的临床病理特征及预后的差异。结果 (1)3种不同病理类型进展期胃癌患者的性别、年龄、神经侵犯及分化程度比较差异无统计学意义(P>0.05),而其肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、淋巴管癌栓、侵犯深度及p TNM分期比较差异有统计学意义(P<0.05)。(2)单因素分析结果显示,胃腺癌患者的预后与肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、侵犯深度及p TNM分期有关(P<0.05),胃黏液腺癌患者的预后与手术根治类型、区域淋巴结转移及p TNM分期有关(P<0.05),胃印戒细胞癌患者的预后与区域淋巴结转移、侵犯深度及p TNM分期有关(P<0.05)。(3)将与3种不同病理类型进展期胃癌患者预后有关的因素进一步行Cox多因素分析,结果显示,肿瘤位置(P=0.016)、区域淋巴结转移(P=0.042)、侵犯深度(P=0.021)及p TNM分期(P=0.009)是影响胃腺癌患者预后的独立危险因素,区域淋巴结转移是影响胃黏液腺癌患者预后的独立危险因素(P=0.000),肿瘤侵犯深度(P=0.032)及区域淋巴结转移(P=0.002)是影响胃印戒细胞癌患者预后的独立危险因素。(4)随访时间60个月,胃腺癌患者的中位随访时间为32个月,胃黏液腺癌患者为43个月,胃印戒细胞癌患者为23个月,5年累积生存率胃腺癌患者为30.2%,胃黏液腺癌患者为23.3%,胃印戒细胞癌患者为26.7%。三者生存曲线比较差异无统计学(P=0.131)。结论不同病理类型进展期胃癌患者的临床病理特征有一定的差异,从而影响其预后的因素也不同,但是区域淋巴结转移是影响3种不同病理类型进展期胃癌患者的共同预后因素。
Objective To investigate the clinicopathological features and prognostic factors of patients with advanced gastric cancer of different pathological types. Methods A retrospective analysis of clinicopathological data of 98 patients with advanced gastric cancer who underwent radical gastrectomy at Suqian People’s Hospital, Drum Tower Hospital affiliated to Nanjing University Medical School from 2011 to 2011 included 53 cases of gastric adenocarcinoma, 30 cases of gastric mucinous adenocarcinoma, 15 cases of ring cell carcinoma, compared with different pathological types of advanced gastric cancer patients with clinicopathological features and prognosis differences. Results (1) There were no significant differences in gender, age, nerve invasion and differentiation between the three kinds of advanced gastric cancer patients with different pathological types (P> 0.05), but their tumor diameter, tumor location, radical operation type, regional lymph node metastasis , Lymphatic cancer emboli, invasion depth and p TNM stage were significantly different (P <0.05). (2) The results of univariate analysis showed that the prognosis of patients with gastric adenocarcinoma was related to tumor diameter, tumor location, radical operation type, regional lymph node metastasis, invasion depth and p TNM stage (P <0.05) The type of operation, regional lymph node metastasis and p TNM stage (P <0.05), and the prognosis of patients with signet ring cell carcinoma were related to regional lymph node metastasis, invasion depth and p TNM stage (P <0.05). (3) The Cox multivariate analysis of the factors related to the prognosis of 3 advanced gastric cancer patients with different pathological types showed that the tumor location (P = 0.016), regional lymph node metastasis (P = 0.042), invasion depth (P = 0.021) and p TNM stage (P = 0.009) were independent risk factors for prognosis of gastric adenocarcinoma. Regional lymph node metastasis was an independent risk factor for prognosis of gastric mucinous adenocarcinoma (P = 0.000) ) And regional lymph node metastasis (P = 0.002) were independent risk factors for the prognosis of patients with gastric signet ring cell carcinoma. (4) The follow-up time was 60 months. The median follow-up time was 32 months in patients with gastric adenocarcinoma, 43 months in gastric mucinous adenocarcinoma, 23 months in gastric signet-ring cell carcinoma, and 5-year cumulative survival rate of gastric adenocarcinoma 30.2% of patients, 23.3% of patients with gastric mucinous adenocarcinoma, 26.7% of patients with signet ring cell carcinoma of the stomach. There was no significant difference between the three survival curves (P = 0.131). Conclusions The clinicopathological features of patients with advanced gastric cancer with different pathological types are different, and the prognostic factors are also different. However, regional lymph node metastasis is the common prognostic factor in patients with advanced gastric cancer of three different pathological types.