摘要
目的探讨不同病理亚型胃印戒细胞癌(GSRC)患者的临床病理特征、预后及其影响因素。方法回顾性收集2016年1月-2018年12月兰州大学第二医院收治的经病理确诊的232例GSRC患者的临床资料。按照WHO诊断标准进行分类,其中胃纯印戒细胞癌(pGSRC)36例,胃混合印戒细胞癌(mGSRC)196例,随访截至2022年9月30日。应用Kaplan-Meier法进行生存分析,单因素及多因素Cox回归分析影响GSRC患者预后的危险因素。结果pGSRC和mGSRC患者中位生存时间分别为41.0(6.0~70.0)个月、24.0(2.0~74.0)个月。Kaplan-Meier生存分析显示,合并糖尿病、合并贫血、神经侵犯、脉管侵犯、T分期、N分期、GSRC病理类型、CA125和肿瘤直径可影响GSRC患者根治术后总生存期(OS)(P<0.05),而Her-2、是否接受化疗等对GSRC患者根治术后OS无明显影响(P>0.05)。单因素Cox回归分析显示,合并糖尿病(P=0.031)、合并贫血(P=0.028)、肿瘤直径>5 cm(P=0.009)、神经侵犯(P=0.002)、脉管侵犯(P=0.002)、病理类型为mGSRC(P=0.039)、T_(2)-T_(4)分期(P=0.001)、N_(1)-N_(4)分期(P=0.004)、p TNMⅢ期(P=0.044)、淋巴结清扫数目>30个(P=0.044)和CA125阳性(P=0.009)是GSRC患者根治术后预后的影响因素。多因素Cox回归分析显示,mGSRC病理类型(P=0.035)、T_(2)-T_(4)分期(P=0.003)和CA125阳性(P=0.010)是GSRC患者根治术后预后不良的独立危险因素。结论与pGSRC相比,mGSRC在确诊时pTNM分期较高,侵袭性较强,中位生存时间较短。mGSRC病理类型、T_(2)-T_(4)分期和CA125阳性是GSRC患者预后不良的独立危险因素。
Objective To explore the clinicopathological characteristics,prognosis and influencing factors of different pathological subtypes of gastric signet ring cell carcinoma(GSRC).Methods A retrospective analysis was performed on the clinical data of 232 patients with GSRC collected from January 2016 to December 2018 in Lanzhou University Second Hospital.According to the WHO classification criteria for GSRC,the patients were divided into pure gastric signet-ring cell carcinoma(pGSRC,n=36)and mixed gastric signet-ring cell carcinoma(mGSRC,n=196).The follow-up as of September 30,2022,the survival analysis was done using Kaplan-Meier method,the univariate and multivariate Cox regression were performed to analyze the risk factors affecting the prognosis of GSRC patients.Results The median survival time of pGSRC and mGSRC patients was 41.0(6.0-70.0)months and 24.0(2.0-74.0)months,respectively.Kaplan-Meier analysis showed that combination with diabetes,anemia,tumor diameter,nerve invasion,lymphovascular invasion,T stage,N stage,GSRC pathological subtype,CA125 and tumor diameter could affect the overall survival(OS)of patients with GSRC after radical gastrectomy(P<0.05),but Her-2,whether adjuvant chemotherapy or not and others elements had no significant effect on OS of GSRC patients after radical gastrectomy(P>0.05).Univariate Cox regression analysis showed that the combination with diabetes(P=0.031),anemia(P=0.028),tumor diameter>5 cm(P=0.009),nerve invasion(P=0.002),lymphovascular invasion(P=0.002),mGSRC pathological type(P=0.039),T_(2)-T_(4) stage(P=0.001),N_(1)-N_(4) stage(P=0.004),pTNM stageⅢ(P=0.044),the number of lymph node metastasis>30(P=0.044)and CA125 positive(P=0.009)were related to the prognosis of patients with GSRC after radical gastrectomy.Multivariate Cox regression analysis showed that mGSRC pathological type(P=0.035),T_(2)-T_(4) stage(P=0.003),CA125 positive(P=0.010)were independent risk factors for poor prognosis of patients with GSRC after radical gastrectomy.Conclusion Compared with pGSRC,patients with mGSRC at diagnosis have higher pTNM stages,more aggressive,and shorter median survival time.mGSRC pathological type,T_(2)-T_(4) stage,and CA125 positive were all independent factors affecting the prognosis of patients with GSRC.
作者
沈亦敏
李元元
王舟
徐伟
李金洲
穆彦熹
姚亚龙
汪文杰
陈晓
Shen Yi-Min;Li Yuan-Yuan;Wang Zhou;Xu Wei;Li Jin-Zhou;Mu Yan-Xi;Yao Ya-Long;Wang Wen-Jie;Chen Xiao(The Second School of Clinical Medicine,Lanzhou University,Lanzhou,Gansu 730013,China;Department of General Surgery,Lanzhou University Second Hospital,Lanzhou,Gansu 730030,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2024年第7期747-753,共7页
Medical Journal of Chinese People's Liberation Army
基金
甘肃省青年科技基金项目(21JR7RA424)。
关键词
印戒细胞癌
胃纯印戒细胞癌
胃混合印戒细胞癌
预后
signet ring cell carcinoma
pure gastric signet-ring cell carcinoma
mixed gastric signet-ring cell carcinoma
prognosis
