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背景与目的:能否行根治性手术切除是影响胃癌预后的重要因素,但施行根治性手术的胃癌患者的远期疗效不尽相同。本研究的目的就是探讨影响胃癌预后的有关因素。方法:回顾性分析我院1985年1月～1995年12月收治的全部行胃癌根治性手术的405例患者的临床资料,采用生命表法进行生存率分析,W ilcoxon秩和检验进行统计学比较,应用Cox比例风险模型进行多因素分析。结果:全组总的5年生存率为43.4%;术后病理分期(pathological TNM,pTNM)Ⅰ、Ⅱ、Ⅲ、Ⅳ期的患者5年生存率分别为75.6%、58.7%、28.0%、18.4%(P<0.01);肿瘤大小<2.0cm、2.0～3.9cm、4.0～5.9cm、6.0～7.9cm、≥8.0cm组的患者5年生存率分别为82.0%、57.4%、43.7%、38.7%、26.9%(P<0.05);有、无辅加围手术期化疗的患者5年生存率分别为47.2%和37.8%。单因素分析表明,围手术期化疗、Borrm ann分型、肿瘤大小、组织学类型、pTNM分期是影响胃癌预后的相关因素。多因素分析显示,pTNM分期、肿瘤大小及围手术期化疗是影响胃癌预后的独立因素。结论:pTNM分期、肿瘤大小及围手术期化疗是影响胃癌根治术预后的最重要因素;施行以手术为中心的围手术期化疗,有助于提高胃癌患者的生存率。
BACKGROUND & OBJECTIVE: Whether or not radical surgical resection is an important factor affecting the prognosis of gastric cancer, the long-term efficacy of gastric cancer patients undergoing radical surgery is not the same. The purpose of this study is to explore the factors that affect the prognosis of gastric cancer. Methods: A retrospective analysis of our hospital from January 1985 to December 1995 admitted to all of the gastric cancer radical operation of 405 patients with clinical data, using life table survival rate analysis, W ilcoxon rank sum test for statistical comparison , Using Cox proportional hazards model for multivariate analysis. Results: The overall 5-year overall survival rate was 43.4%. The 5-year survival rates of patients with pathological TNM stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 75.6%, 58.7%, 28.0% and 18.4 %, Respectively (P <0.01). The 5-year survival rates of patients with tumor size less than 2.0cm, 2.0-3.9cm, 4.0-5.9cm, 6.0-7.9cm and ≥8.0cm were 82.0%, 57.4%, 43.7% and 38.7 % And 26.9% respectively (P <0.05). The 5-year survival rates of patients with and without perioperative chemotherapy were 47.2% and 37.8%, respectively. Univariate analysis showed that perioperative chemotherapy, Borrm ann classification, tumor size, histological type, pTNM stage are the related factors that affect the prognosis of gastric cancer. Multivariate analysis showed that pTNM staging, tumor size and perioperative chemotherapy were independent prognostic factors. CONCLUSION: The pTNM stage, tumor size and perioperative chemotherapy are the most important factors affecting the prognosis of radical operation of gastric cancer. Surgical-centered perioperative chemotherapy is helpful to improve the survival rate of patients with gastric cancer.