| 刘 苗,王英南,赵 群.不同Lauren分型胃癌的临床病理特征及影响胃癌根治术后复发的危险因素分析[J].中国肿瘤,2019,28(12):941-950. |
| 不同Lauren分型胃癌的临床病理特征及影响胃癌根治术后复发的危险因素分析 |
| Clinicopathological Characteristics of Gastric Cancer with Different Lauren Classifications and Risk Factors for Recurrence after Radical Gastrectomy |
| 中文关键词 修订日期：2019-06-29 |
| DOI：10.11735/j.issn.1004-0242.2019.12.A011 |
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| 中文关键词: Lauren分型 胃癌 复发 危险因素 辅助化疗 |
| 英文关键词:Lauren classification gastric cancer recurrence risk factors adjuvant chemotherapy |
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| 中文摘要: |
| 摘 要：［目的］ 探讨不同Lauren分型胃癌的临床病理特征、最佳辅助化疗方案，以及影响胃癌根治术后复发的独立危险因素。［方法］ 回顾性分析268例2014年1月1日至2016年9月30日在河北医科大学第四医院行D2根治术且达R0切除的胃癌患者的病历资料及随访资料，采用SPSS23.0、MedCalc15.8及GraphPad Prism7.0软件进行统计学分析及绘图。比较肠型胃癌与弥漫型胃癌的临床病理特征，通过多因素分析筛选影响胃癌根治术后复发的独立危险因素，并根据Lauren分型及TNM分期进行分层，分别筛选引起不同Lauren分型及不同TNM分期胃癌根治术后复发的独立危险因素。［结果］ （1） 肠型胃癌多位于贲门、组织学高分化，与EGFR、HER-2、P53、TOPOⅡ、Ki67高表达相关，其肿瘤直径偏小，淋巴结阳性率偏低，男性占比较多。弥漫型胃癌多位于非贲门部位、组织低分化，与EGFR、HER-2、p53、TOPOⅡ、Ki67低表达相关，其肿瘤直径偏大，淋巴结阳性率偏高；女性所占比例较肠型胃癌患者多，但仍以男性为主。弥漫型胃癌首诊时CA724升高率明显较肠型胃癌高，且更易发生神经受侵及脉管瘤栓。（2）术后辅助化疗方案、肿瘤最大直径、淋巴结阳性率是胃癌复发的独立危险因素，根治术后应用XELOX方案辅助化疗的复发风险是SOX方案的2.323倍。随着肿瘤最大直径的增大和淋巴结阳性率的增高，胃癌复发风险增加。分层分析中，弥漫型胃癌根治术后应用XELOX方案辅助化疗的复发风险是SOX方案的2.209倍，而术后辅助化疗方案不是肠型胃癌根治术后复发的独立危险因素。Ⅲ期胃癌根治术后应用XELOX方案辅助化疗的复发风险是SOX方案的2.161倍，而术后辅助化疗方案不是Ⅱ期胃癌根治术后复发的独立危险因素。（3）淋巴结阳性率是胃癌根治术后复发的独立危险因素，不同Lauren分型胃癌复发的独立危险因素不同。［结论］ （1）不同Lauren分型的胃癌在临床病理特征、对辅助化疗方案的反应及影响预后的独立危险因素方面均各不相同，以Lauren分型指导个体化治疗具有一定的临床意义。（2） SOX方案可作为有效的辅助化疗方案应用于临床，尤其在Ⅲ期及弥漫型胃癌患者中可能获益更佳。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the clinicopathological characteristics of gastric cancer with different Lauren classifications，and risk factors for recurrence after radical gastrectomy. ［Methods］ The clinical data of 268 patients with gastric cancer who received D2 gastrectomy and R0 resection in the Fourth Hospital of Hebei Medical University from January 2014 to September 2016 were retrospectively analyzed. SPSS23.0，MedCalc15.8 and GraphPad Prism7.0 softwares were used for statistical analysis and plotting. Clinicopathological characteristics of intestinal type gastric cancer and diffuse gastric cancer were compared. The risk factors of recurrence after radical operation were analyzed by multivariate analysis. ［Results］ Most of intestinal type gastric carcinoma was located in cardia and highly differentiated；in intestinal type gastric cancer the expression of EGFR，HER-2，p53，TOPOⅡand Ki67 was high，the diameter of the tumor was smaller，the positive rate of lymph node was lower，and more male patients than female. The diffuse type of gastric cancer mostly located in the non-cardiac region with low differentiation；in diffuse type gastric cancer，the expression of EGFR，HER-2，P53，TOPOⅡand Ki67 was low，the diameter of the tumor was larger and the positive rate of lymph nodes was higher，and there were more female patients than those of intestinal type gastric cancer patients，but the male was still the dominant one. The percentage of elevated CA724 at the first diagnosis of diffuse type was significantly higher than that of intestinal type，and the diffuse type was more prone to nerve invasion and blood vessel invasion. Adjuvant chemotherapy regimen，maximum diameter of tumor and positive rate of lymph node were independent risk factors for recurrence of gastric cancer. The recurrence risk of XELOX regimen was 2.323 times higher than SOX regimen. With the increasing of the maximum diameter of the tumor and the positive rate of lymph nodes，the risk of recurrence of gastric cancer increased. The recurrence risk of adjuvant chemotherapy with XELOX regimen in stage Ⅲ gastric cancer was 2.161 times higher than SOX regimen. The positive rate of lymph nodes was an independent risk factor for recurrence of gastric cancer post radical resection. The independent risk factors for recurrence in gastric cancer with different Lauren classification were different. ［Conclusion］ The clinicopathological characteristics，response to adjuvant chemotherapy and independent risk factors affecting prognosis of gastric cancer with different Lauren classification are different. It has certain clinical significance to guide individualized treatment by Lauren classification. SOX regimen can be used as an effective adjuvant chemotherapy，especially in patients with stage Ⅲ and diffuse gastric cancer. |
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