影響胃癌患者術后生存因素的Cox回歸分析_《中國普外基礎與臨床雜志》

作者：

韓方海 ¹ , 詹文華 ² , 張肇達 ¹ , 何裕隆 ² , 周祥 ¹

1.四川大學華西醫院普外科（成都610041）;;
2.中山大學附屬第一醫院外科（廣州510080）;;
通訊作者：詹文華;

關鍵詞：

胃癌生存率影響因素 Cox分析

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目的探討胃癌臨床病理特征及治療方法對患者生存率的影響。
方法以1994年4月至2005年8月手術治療和病理確診且隨訪資料完整的759 例胃癌患者為對象，對其外科治療結果進行回顧性分析，用Kaplan-Meier計算3年和5年生存率，用Log-rank單因素比較和Cox 回歸多因素分析比較，分析影響胃癌患者術后生存率的因素。隨訪時間為4～131個月，平均（62.3±6.7）個月。
結果單因素分析表明，患者的年齡、腫瘤部位、腫瘤直徑、Borrmann分型、組織學類型、TNM分期、腫瘤浸潤深度、淋巴結轉移、肝轉移、腹腔種植、術中輸血、根治范圍及清掃方法均為影響胃癌患者術后生存的影響因素。經Cox回歸多因素分析發現，腫瘤部位、直徑、浸潤深度、術中輸血、淋巴結清掃范圍、淋巴結轉移、清掃方法、肝轉移、腹腔種植及TNM分期為影響患者術后生存的獨立預后因素。
結論影響胃癌患者術后生存的獨立因素有腫瘤部位、大小、淋巴結轉移、腫瘤浸潤深度、腹腔種植、肝轉移、病理分期，根治手術范圍、淋巴結清掃技術及術中輸血是影響患者術后生存率的重要因素。

引用本文： 韓方海,詹文華,張肇達,何裕隆,周祥. 影響胃癌患者術后生存因素的Cox回歸分析. 中國普外基礎與臨床雜志, 2006, 13(1): 29-33下轉37. doi: 復制

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9.	Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [Ｊ]. Eur J Surg Oncol， 2004; 30(3)∶303.
10.	McCulloch P, Nita ME, Kazi H, et al. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach [Ｊ]. Cochrane Database Syst Rev， 2003; (4)∶CD001964.
11.	Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
12.	Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: longterm results of the MRC randomized surgical trial. Surgical Cooperative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
13.	太田惠一郎，大山繁和，高橋孝，他. 胃癌手術の歷史的変遷 [Ｊ]. 消化器外科， 1999； 22（7）∶1175.
14.	Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomy——Japan Clinical Oncology Group study 9501 [Ｊ]. J Clin Oncol, 2004; 22(14)∶2767.
15.	Bunt AM, Hermans J, Boon MC, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western versus Japanesetype surgery in gastric cancer [Ｊ]. J Clin Oncol, 1994; 12(2)∶417.
16.	Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach. A patient care study by the American College of Surgeons [Ｊ]. Ann Surg, 1993; 218(5)∶58317McCulloch P. Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985 [Ｊ]. Br J Surg, 1994; 81(3)∶417.
17.	Bonenkamp JJ, van de Velde CJ, Kampschoer GH, et al. Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients [Ｊ]. World J Surg, 1993; 17(3)∶410.
18.	Kaneda M, Horimi T, Ninomiya M, et al. Adverse affect of blood transfusions on survival of patients with gastric cancer [Ｊ]. Transfusion, 1987; 27(5)∶375.
19.	Eroglu A, Canpinar H, Kansu E. Influence of perioperative whole blood transfusions on lymphocyte subpopulations in patients with stage Ⅱ breast cancer [Ｊ]. Med Oncol, 1999; 16(1)∶53.
20.	Blumberg N, Heal J, Chuang C, et al. Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence [Ｊ]. Ann Surg, 1988; 207(4)∶410.

1. Hartgrink HH, van de Velde CJ. Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer [Ｊ]. J Surg Oncol， 2005; 90(3)∶153.
2. 陳峻青. 胃腸外科學 \[A\] .見：王吉甫主編. 胃癌 \[M\]. 第1版. 北京：人民衛生出版社， 2000∶360～397.
3. Kranenbarg EK, van de Velde CJ. Gastric cancer in the elderly [Ｊ]. Eur J Surg Oncol， 1998; 24(5)∶384.
4. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial [Ｊ]. Br J Surg， 1997; 84(11)∶1567.
5. 詹文華. 胃近、遠端癌臨床療效差異的評價 [Ｊ]. 中國普通外科雜志， 2002; 11（4）∶ 193.
6. 劉統成，詹文華. 早期胃癌病理特點的認識及手術治療的新進展 [Ｊ]. 中華胃腸外科雜志， 1999； 2（1）∶ 61.
7. 何裕隆，陳創奇，鄭章清，等. 胃癌侵犯或累及胰十二指腸區域的手術治療選擇 [Ｊ]. 中國實用外科雜志， 2000; 20（11）∶658.
8. Furukawa H, Hiratsuka M, Iwanaga T. A rational technique for surgical operation on Borrmann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby’s method [Ｊ]. Br J Surg， 1988; 75(2)∶116.
9. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [Ｊ]. Eur J Surg Oncol， 2004; 30(3)∶303.
10. McCulloch P, Nita ME, Kazi H, et al. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach [Ｊ]. Cochrane Database Syst Rev， 2003; (4)∶CD001964.
11. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
12. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: longterm results of the MRC randomized surgical trial. Surgical Cooperative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
13. 太田惠一郎，大山繁和，高橋孝，他. 胃癌手術の歷史的変遷 [Ｊ]. 消化器外科， 1999； 22（7）∶1175.
14. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomy——Japan Clinical Oncology Group study 9501 [Ｊ]. J Clin Oncol, 2004; 22(14)∶2767.
15. Bunt AM, Hermans J, Boon MC, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western versus Japanesetype surgery in gastric cancer [Ｊ]. J Clin Oncol, 1994; 12(2)∶417.
16. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach. A patient care study by the American College of Surgeons [Ｊ]. Ann Surg, 1993; 218(5)∶58317McCulloch P. Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985 [Ｊ]. Br J Surg, 1994; 81(3)∶417.
17. Bonenkamp JJ, van de Velde CJ, Kampschoer GH, et al. Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients [Ｊ]. World J Surg, 1993; 17(3)∶410.
18. Kaneda M, Horimi T, Ninomiya M, et al. Adverse affect of blood transfusions on survival of patients with gastric cancer [Ｊ]. Transfusion, 1987; 27(5)∶375.
19. Eroglu A, Canpinar H, Kansu E. Influence of perioperative whole blood transfusions on lymphocyte subpopulations in patients with stage Ⅱ breast cancer [Ｊ]. Med Oncol, 1999; 16(1)∶53.
20. Blumberg N, Heal J, Chuang C, et al. Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence [Ｊ]. Ann Surg, 1988; 207(4)∶410.

《中國普外基礎與臨床雜志》

影響胃癌患者術后生存因素的Cox回歸分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

影響胃癌患者術后生存因素的Cox回歸分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料