摘要
目的 分析老年胃癌患者临床病理特征及预后,为临床策略制定提供依据.方法 回顾性分析2008 年8 月至2017 年12 月在西京医院就诊、年龄大于70 岁并且接受根治性手术的胃癌患者临床病理资料,研究不同因素与预后的关系.结果 共纳入患者 566 例,平均年龄 73.9 岁,其中男性 434 例(76.7%),女性 132 例(23.3%).患者术后中位生存时间71.4 个月,5 年生存率为51.8%.单因素分析显示,术前白蛋白、癌胚抗原、糖类抗原125(CA125)、糖类抗原19-9、甲胎蛋白、胃切除方式、肿瘤大小、分化程度、T分期、N分期、术中出血量、脉管侵犯、周围神经浸润与老年胃癌患者预后相关(P<0.05).多因素分析表明,肿瘤大小、T分期、N分期、术中出血量、脉管侵犯、周围神经浸润、术前 CA125 是老年胃癌根治术患者预后的独立影响因素(P<0.05).生存分析结果表明,肿瘤直径≥4 cm、浸润深度越深、转移淋巴结越多、术中出血量≥250 mL、术前CA125 异常及伴随脉管侵犯、周围神经浸润的患者预后更差(均P<0.05).结论 术前血清CA125 水平、肿瘤大小、术中出血量、T分期、N分期、脉管侵犯、周围神经浸润是老年胃癌根治术患者的重要预后指标.
Abstract
Objective To analyze the clinicopathological characteristics and prognosis of elderly patients with gastric cancer,so as to provide a therapeutic approach for clinical strategy development.Methods The clinicopathological data of patients with gastric cancer who were older than 70 years and underwent radical surgery in Xijing Hospital from August 2008 to December 2017 were retrospectively analyzed to study the relationship between different factors and prognosis.Results This study included 566 patients with an average age of 73.9 years,including 434 males(76.7%)and 132 females(23.3%).The median survival time of patients after surgery was 71.4 months,and the 5-year survival rate was 51.8%.Univariate analysis showed that preoperative albumin,carcinoembryonic antigen,carbohydrate antigen 125(CA125),carbohydrate antigen 19-9,alpha-fetoprotein,mode of gastrectomy,tumor size,degree of differentiation,T stage,N stage,intraoperative blood loss,lymphovascular invasion,and perineural infiltration were correlated with the prognosis of elderly patients with gastric cancer(P<0.05).Multivariate analysis showed that tumor size,T stage,N stage,intraoperative blood loss,lymphovascular invasion,perineural infiltration,and preoperative CA125 were independent prognostic factors of elderly patients with gastric cancer(P<0.05).Survival analysis showed that patients with tumor size≥4 cm,deeper infiltration depth,more metastatic lymph nodes,intraoperative blood loss≥250 mL,preoperative CA125 abnormality,lymphovascular invasion and perineural infiltration had a worse prognosis(all P<0.05).Conclusion Preoperative serum CA125 levels,tumor size,intraoperative blood loss,T stage,N stage,lymphovascular invasion and perineural infiltration are important prognostic indicators in elderly patients with gastric cancer after radical resection.
维普
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