食管胃结合部腺癌及胃癌Cox模型预后影响因素分析
Analysis of Cox Model Prognostic Determinants of Gesophagogastric Junction Adenocarcinoma and Gastric Carcinoma
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摘要:目的 分析食管胃结合部腺癌及胃癌各自的独立预后影响因素。方法 收集本院2007年1月至2011年6月院340例术后食管胃结合部腺癌及胃癌病例, 选择13项临床病理因素(性别、年龄、病变长度、病理类型、淋巴结转移情况、浸润深度、临床分期、周围器官受侵情况、残端情况、脉管瘤栓、术中淋巴结清扫程度及出现症状到首诊治疗时间)分别进行Cox单因素及多因素分析。结果 1) 食管胃结合部腺癌与胃癌比较预后更差; 2)淋巴结清扫及淋巴结转移均为二者的独立预后影响因素, 淋巴结转移个数越多, 患者预后越差, D2式手术较D1式手术可能带来更大的生存获益; 3)浸润深度为食管胃结合部腺癌的独立预后影响因素, 浸润越深预后越差; 而病变长度为胃癌的独立预后影响因素, 病变越长预后越差。结论 与胃癌相比, 食管胃结合部腺癌预后更差, 并且有其独特的临床病理特征及预后影响因素, 提示二者有所区别, 今后应将食管胃结合部腺癌做为一种独立的疾病开展更加深入的研究。Abstract:Objective To analyze the prognosis and independent prognostic factors of esophagogastric junction adenocarcinoma and gastric carcinoma.Methods Thirteen clinico-pathologic factors related to the prognosis of patients with gastric carcinoma were analyzed by univariate and multivariate Cox regression proportional hazard models.Results Esophagogastric junction adenocarcinoma has worse prognosis than gastric carcinoma.The status of lymph node metastasis and the degree of node dissection are the independent prognostic determinants of both esophagogastric junction adenocarcinoma and gastric carcinoma.Prognosis worsens with increasing number of lymph node metastases.D2-type radical resection can produce greater survival benefits than D1-type radical resection.Invasive depth and lesion extent are the independent prognostic determinants of esophagogastric junction adenocarcinoma and distal gastric carcinoma, respectively.Prognosis worsens as invasive depth becomes deeper and as lesion extent becomes higher.Conclusion Compared with stomach cancer, esophagogastric junction adenocarcinoma has worse prognosis.It also has unique clinical and pathological features and independent prognostic determinants.In-depth research should be conducted on esophageal gastric adenocarcinoma as an independent disease.
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