摘要
目的探讨残胃上的癌（CRS）患者的临床病理特征及预后影响因素。方法回顾性分析青岛大学附属医院胃肠外科2000年1月至2017年3月间收治的217例CRS患者临床病理资料。CRS定义为胃切除术后残胃出现的原发癌，无论首次手术胃疾病性质和切除范围，且不约束特定时间间隔。对良性疾病术后CRS与胃癌术后CRS两组患者的临床病理特征和治疗情况进行比较，并通过Cox模型分析全组患者的预后影响因素。结果217例患者中男189例，女28例；CRS发生年龄（60.9 ± 11.2）岁；首次手术距CRS发生的间隔时间为（18.3 ± 15.1）年。良性疾病术后CRS组108例，胃癌术后CRS组109例。与胃癌术后CRS组相比，良性疾病术后CRS组男性患者比例较高[92.6%（100/108）比81.7%（89/109），χ2=5.779，P= 0.016]，术后发生CRS的间隔时间较长[30（25～40）年比4（1.5～8.0）年，Z=-11.685，P= 0.000]，肿瘤直径更大[（5.9 ± 3.2）cm比（3.9 ± 2.4）cm，t= 3.390，P= 0.000]，分期更晚[Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者例数分别为6（8.0%）、14（18.7%）、41（54.7%）、14例（18.7%）和16（25.4%）、14（22.2%）、21（33.3%）、12例（19.0%），Z=-2.018，P= 0.044]。138例患者行手术治疗，其中118例（85.5%）为根治性手术，20例（14.5%）为姑息性手术；另有79例患者因肿瘤广泛转移或其他原因未行手术治疗。手术治疗的138例CRS患者中，行内镜下切除3例，微创手术（腹腔镜或机器人手术）6例，开放手术129例，联合脏器切除48例；术后住院时间10（8～14）d，术后并发症发生率23.2%（32/138）；91例（65.9%）术后获得7～120个月的随访，其中良性疾病术后CRS组和胃癌术后CRS组分别为51例和40例，75例根治性切除术后患者1、3、5年生存率分别为80.7%、55.1%和41.6%；良性疾病术后CRS组患者1、3、5年生存率分别为73.5%、48.3%和29.0%；胃癌术后CRS组则分别为83.1%、51.2%和32.5%；两组差异无统计学意义（P= 0.527）。多因素分析显示，年龄（RR= 1.879，95%CI：1.015～3.479，P= 0.045）、手术根治性（RR= 2.956，95%CI：1.421～6.150，P= 0.004）和TNM分期（RR= 1.570，95%CI：1.047～2.354，P= 0.029）是影响CRS患者预后的独立因素。结论良性疾病术后发生CRS与恶性疾病术后发生CRS相比，男性患者比例较高，时间间隔较长，肿瘤直径更大和分期更晚。CRS根治性切除预后较好。
Objective To evaluate the clinicopathological features and prognostic factors of carcinoma in the remnant stomach （CRS）. Methods Clinicopathological data of 217 consecutive CRS patients from January 2000 to March 2017 at Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University were retrospectively analyzed. CRS was defined as the primary cancerarising from the remnant stomach following gastrectomy, regardless of the initial disease or operation, and at no special time interval. The clinicopathological features and treatment were compared between CRS after benign disease operation （CRS-B） group and CRS after gastric cancer operation （CRS-C） group, and factors influencing prognosis were analyzed using Cox regression model analysis. Results Of 217 patients, 189 were male and 28 were female with mean age of （60.9±11.2） years. The interval between the first and the second operations was （18.3±15.1） years. The CRS-B group comprised 108 patients and the CRS-C group comprised 109 patients. Compared to CRS-C group, CRS=B group had higher ratio of male [92.6% （100/108） vs. 81.7% （89/109）, x2= 5.779, P = 0.016], longer interval [30（25-40） years vs. 4（1.5-8.0） years, Z = -11.685, P = 0.000], longer tumor diameter [（5.9 ± 3.2） cm vs. （3.9 ±2.4） era, t = 3.390, P = 0.000] and later tumor stage [patients in stage Ⅰ、Ⅱ、Ⅲ、Ⅳ. 6 （8.0%）, 14 （18.7%）, 41 （54.7%）, and 14 （18.7%） vs. 16 （25.4%）, 14 （22.2%）, 21（33.3%）, and 12（19.0%）, respectively, Z= -2.018, P = 0.044]. A total of 138 patients underwent surgery, including 118 （85.5%） patients of curative resection and 20 （14.5%） patients of palliative resection. The other 79 patients did not receive surgery due to extensive metastasis or miscellaneous reasons. Among 138 patients receiving surgery, 3 patients underwent endoscopic resection, 6 patients underwent minimally invasive surgery （laparoseopy or robot）, and 129 patients underwent laparotomy. Forty-eight patients underwent surgery involving combined resection. The median postoperative hospital stay was 10 （8-14） days. The incidence of postoperative complication was 23.2%（32/138）. A total of 91 patients were followed up for 7-120 months, including 51 patients in CRS-B group and 40 in CRS-C group. The overall 1-, 3-, and 5-year survival rates of the 75 patients receiving curative resection were 80.7%, 55.1%, and 41.6%, respectively. The overall 1-, 3-, and 5-year survival rates were 73.5%, 48.3%, and 29.0% respectively in CRS-B group and 83.1%, 51.2%, and 32.5% respectively in CRS-C group. There was no significant difference between two groups （P = 0.527）. Multivariate analysis showed that age （RR=1.879, 95%CI： 1.015-3.479, P=0.045）, radical procedure （RR = 2.956, 95%CI： 1.421-6.150, P= 0.004） and TNM stage （RR=I.570, 95%CI： 1.047-2.354, P=0.029） were independent prognostic factors for CRS. Conclusions As compared to the CRS-C group, the CRS-B group has higher percentage of male, longer interval, larger tumor diameter and later TNM stage. Radical resection indicates better prognosis.
作者
刘晓东
牛兆建
陈栋
王东升
吕亮
江海涛
张坚
李宇
曹守根
周岩冰
Liu Xiaodong;Niu Zhaojian;Chen Dong;Wang Dongsheng;Lyu Liang;Jiang Haitao;Zhang Jian;Li Yu;Cao Shougen;Zhou Yanbing(Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第5期535-540,共6页
Chinese Journal of Gastrointestinal Surgery
基金
青岛市民生科技计划项目（14-2-3-5-nsh）
关键词
残胃上的癌
临床病理特征
预后
Carcinoma in the remnant stomach
Clinicopathological characteristics
Prognosis
