基于癌结节状态及复发模式改良Ⅱ/Ⅲ期胃癌患者根治术后随访计划的研究
Improving a follow-up plan based on the tumor deposits status and recurrence pattern of stage Ⅱ/Ⅲ gastric cancer patients after radical gastrectomy
华科雷 1霍明科 1董志闯 1李森 1张贺 2任莹坤 1曹轶3
作者信息
- 1. 郑州大学附属肿瘤医院河南省肿瘤医院普外科,郑州 450008
- 2. 郑州大学附属肿瘤医院河南省肿瘤医院病理科,郑州 450008
- 3. 华北理工大学公共卫生学院,唐山 063000
- 折叠
摘要
目的 探讨Ⅱ/Ⅲ期胃癌患者根治性切除术后癌结节状态与复发模式之间的关系,并对癌结节阳性患者制定个性化随访计划.方法 回顾性分析2015年9月至2018年9月在河南省肿瘤医院接受根治性手术的706例Ⅱ/Ⅲ期胃癌患者,根据其癌结节状态将患者分为癌结节阳性组(TDs+112例)和癌结节阴性组(TDs-594例),比较两组患者的临床病理特征和复发模式,并得到改良后的随访计划.结果 TDs-组患者的1、3年总生存率和无病生存率均高于TDs+组(92.4％、72.2％比79.4％、38.8％;87.9％、68.6％比66.7％、35.9％),差异均有统计学意义(均P＜0.05).TDs+组和TDs-组腹膜转移率分别33.0％、14.5％,远处转移率分别为21.4％、10.8％,差异均有统计学意义(x2=21.285、8.851,均P＜0.05).TDs+组患者远处转移的中位时间明显早于TDs-组,差异有统计学意义(9.0个月比15.4个月,Z=-2.294,P=0.022).TDs+组腹膜转移复发风险高于TDs-,并且呈现双复发峰,复发高峰分别在术后8.5个月和15.0个月.TDs+组远处转移复发风险高于TDs-组,在6个月时出现单复发高峰.结论 TDs+和TDs-患者术后的复发模式有差异,改良后的随访计划可提高复发的早期检出率.
Abstract
Objective To investigate the relationship between cancer node status identified after radical resection and patterns of recurrence in stage Ⅱ/Ⅲ gastric cancer patients for developing personalized follow-up plans in node-positive patients.Methods A retrospective analysis was conducted on 706 stage Ⅱ/Ⅲ gastric cancer patients who underwent curative intent surgery at Henan Cancer Hospital from Sep 2015 to Sep 2018.Patients were categorized into node-positive(TDs+)and node-negative(TDs-)groups based on their cancer node status.Clinical-pathological characteristics and recurrence patterns were compared between the groups to formulate an optimized follow-up plan.Results Among the patients,there were 112 TDs+and 594 TDs-cases.TDs-patients exhibited significantly better overall survival and disease-free survival rates at 1 and 3 years compared to the TDs+group(92.4％,72.2％vs 79.4％,38.8％;87.9％,68.6％vs.66.7％,35.9％,all P＜0.05).The cumulative recurrence rates of peritoneal and distant metastases were higher in TDs+patients compared to TDs-patients,with statistical significance(33.0％vs.14.5％,21.4％vs.10.8％,x2=21.285,8.851 all P＜0.05).TDs+patients experienced significantly earlier median time to distant metastasis compared to TDs-patients(9.0 months vs.15.4 months,Z=-2.294 P=0.022).The risk of peritoneal metastasis recurrence was higher in the TDs+group,showing a bimodal recurrence pattern at 8.5 and 15.0 months post-surgery.TDs+patients also had a higher risk of distant metastasis recurrence,with a single peak at 6 months.Conclusion Postoperative recurrence patterns differ between TDs+and TDs-patients,and an optimized follow-up plan can enhance early detection of recurrence.
关键词
胃肿瘤/复发/随访研究/癌结节Key words
Stomach neoplasms/Recurrence/Follow-up studies/Tumor deposits引用本文复制引用
出版年
2024
NETL
NSTL
万方数据