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目的分析淋巴结阴性胃癌患者的临床病理特点,寻找其独立预后因素,探讨辅助化疗在本组胃癌患者治疗的价值。方法回顾性分析455例行D2根治术、术后病理检查结果提示无淋巴结转移(pTis-4N0M0)胃腺癌患者临床、病理资料,单因素及多因素分析年龄、性别、分化程度、肿瘤部位、T分期、肿瘤大小及淋巴结清扫数目等对患者预后的影响,对比行辅助化疗及未行辅助化疗患者的生存情况。结果全组患者中位生存时间为77.5个月,1年生存率94.9%,3年生存率86.6%,5年生存率79.3%,10年生存率76.9%。COX多因素回归分析得出病理类型、肿瘤大小、T分期和清扫淋巴结数目是独立预后因素。pT2N0M0/pT3N0M0组胃癌患者行辅助化疗与未行辅助化疗5年生存率分别为76.6%和87.7%,差异无统计学意义(P=0.071);pT4aN0M0组患者行辅助化疗与未行辅助化疗5年生存率分别为85.6%和64.3%,差异有统计学意义(P=0.006)。结论病理类型、肿瘤大小和T分期、清扫淋巴结数目是独立预后因素;辅助化疗未能改善pT2N0M0/pT3N0M0组胃癌患者的预后,pT4aN0M0组胃癌患者辅助化疗则有价值。
Objective To analyze the clinicopathological characteristics of patients with lymph node-negative gastric cancer and to find out its independent prognostic factors and explore the value of adjuvant chemotherapy in the treatment of patients with gastric cancer. Methods Retrospective analysis of 455 cases of radical resection of D2, postoperative pathology showed no lymph node metastasis (pTis-4N0M0) in patients with gastric adenocarcinoma clinical, pathological data, univariate and multivariate analysis of age, sex, degree of differentiation, tumor site, T Staging, tumor size and the number of lymph node dissection on the prognosis of patients, compared with adjuvant chemotherapy and without adjuvant chemotherapy in patients with survival. Results The median survival time was 77.5 months. The 1-year survival rate was 94.9%, the 3-year survival rate was 86.6%, the 5-year survival rate was 79.3%, and the 10-year survival rate was 76.9%. COX multi-factor regression analysis showed that pathological type, tumor size, T stage and the number of lymph nodes were independent prognostic factors. The 5-year survival rates of patients with pT2N0M0 / pT3N0M0 gastric cancer were 76.6% and 87.7%, respectively, with no significant difference (P = 0.071). Patients in pT4aN0M0 group had adjuvant chemotherapy and no adjuvant chemotherapy for 5 years Survival rates were 85.6% and 64.3%, respectively, with significant differences (P = 0.006). Conclusions The pathological type, tumor size, T stage and the number of lymph nodes disseminated are independent prognostic factors. Adjuvant chemotherapy can not improve the prognosis of patients with gastric cancer of pT2N0M0 / pT3N0M0 group. Adjuvant chemotherapy of gastric cancer patients of pT4aN0M0 group is valuable.