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目的:探讨胃癌腹膜转移的危险因素及其预后。方法:回顾性分析352例胃癌患者的临床病理资料进行。结果:全组腹膜转移的发生率为15.1%(53/352)。单因素分析显示,胃癌腹膜转移与性别、组织学类型、浸润深度、淋巴结转移、TNM分期、手术方式及局部复发等有关(均P<0.01);多因素分析显示,胃癌腹膜转移独立危险因素是胃壁浸润深度(P=0.016,95%CI=0.570~0.945),TNM分期(P<0.001,95%CI=2.414~4.027),淋巴结转移(P=0.027,95%CI=1.041~1.964),手术方式(P<0.001,95%CI=1.203~1.870),局部复发(P<0.001,95%CI=1.376~2.871);腹膜转移患者1,2年生存率分别为44%和10%,而无转移患者分别为97.0%和74.0%,两组间生存率差异有统计学意义(χ2=249.411,P<0.001)。结论:胃癌伴腹膜转移预示肿瘤的恶性程度高,预后较差;而胃壁浸润深度,TNM分期,淋巴结转移,手术方式及局部复发等因素是影响胃癌腹膜种植转移的独立危险因素。
Objective: To investigate the risk factors and prognosis of peritoneal metastasis of gastric cancer. Methods: A retrospective analysis of 352 cases of gastric cancer patients with clinical and pathological data. Results: The incidence of peritoneal metastasis in the whole group was 15.1% (53/352). Univariate analysis showed that peritoneal metastasis of gastric cancer was related to gender, histological type, depth of invasion, lymph node metastasis, TNM staging, surgical approach and local recurrence (all P <0.01). Multivariate analysis showed that the independent risk factors for peritoneal metastasis of gastric cancer were (P = 0.016, 95% CI = 0.570-0.945), TNM stage (P <0.001,95% CI 2.414-4.027), lymph node metastasis (P = 0.027, 95% CI 1.041-1.964) (P <0.001,95% CI = 1.203-1.870), with local recurrence (P <0.001,95% CI = 1.376-2.871). The 1-year and 2-year survival rates of peritoneal metastases were 44% and 10% Metastatic patients were 97.0% and 74.0%, respectively, with significant differences in survival between the two groups (χ2 = 249.411, P <0.001). CONCLUSIONS: Gastric cancer with peritoneal metastasis indicates that the malignant degree of the tumor is high and the prognosis is poor. Factors such as depth of gastric wall invasion, TNM stage, lymph node metastasis, surgical approach and local recurrence are independent risk factors for peritoneal metastasis of gastric cancer.