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目的探讨胃癌肝转移患者长期总体生存率的预后因素。方法回顾性分析72例胃癌肝转移患者的临床资料,比较患者接受不同治疗后的生存率,并对年龄、性别、肿瘤大小、分化程度、浸润深度、淋巴管浸润、静脉浸润、淋巴结转移行单因素及多因素分析,明确独立预后因素。结果 26例胃癌肝转移灶切除患者术后1、3、5年生存率分别为65.2%、35.6%、16.8%,3例生存超过5年;单因素分析显示肝转移、腹膜扩散、肿瘤浸润深度、淋巴管浸润、淋巴结转移是胃癌肝转移预后因素,但多因素分析显示前两者是有显著意义的预后因素。在H1/H2P0患者中,根治性手术、孤立性肝转移灶、无远处淋巴结转移是独立危险因素。结论肝转移、腹膜扩散等是影响预后的独立危险因素。为改善H1/H2P0胃癌患者的预后,应进行包括转移性肝癌在内的根治性手术。
Objective To investigate the prognostic factors of long-term overall survival in patients with gastric cancer liver metastases. Methods The clinical data of 72 patients with liver metastases from gastric cancer were retrospectively analyzed. The survival rates of patients after different treatments were compared. The age, sex, tumor size, differentiation degree, depth of invasion, lymphatic vessel infiltration, venous infiltration, lymph node metastasis were examined. Factors and multivariate analysis confirmed independent prognostic factors. Results The survival rates of 1, 2 and 5 years after operation were 26%, 35.6%, and 16.8%, respectively. The survival rate of 3 patients surpassed 5 years. Univariate analysis showed liver metastasis, peritoneal diffusion, and depth of tumor invasion. Lymphatic infiltration and lymph node metastasis were the prognostic factors of gastric cancer liver metastasis, but multivariate analysis showed that the first two were significant prognostic factors. In H1/H2P0 patients, radical surgery, isolated liver metastases, and distant lymph node metastasis were independent risk factors. Conclusion Liver metastasis and peritoneal diffusion are independent risk factors for prognosis. In order to improve the prognosis of H1/H2P0 gastric cancer patients, radical surgery including metastatic liver cancer should be performed.