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目的探讨影响胃癌患者长期生存的独立预后因素。方法采用Cox比例风险模型对可能影响胃癌患者预后的15个临床病理、治疗措施及分子生物学指标,进行多因素回归分析。结果单因素分析显示TNM分类、病期、肿瘤生长方式、淋巴管静脉侵犯、术前动脉插管介入化疗、术后腹腔化疗、CD44拼接变异体V6(CD44V6)和E-钙黏附素(E-CD)表达及增殖细胞核抗原标记指数(PCNALI)与胃癌患者术后生存率显著相关(P均<0.05)。Cox多因素回归分析显示,按作用强度、TNM分类、术前动脉插管介入化疗、术后腹腔化疗、肿瘤生长方式依次为影响胃癌患者长期存活的预后因素。结论TNM分类、术前动脉插管介入化疗、术后腹腔化疗、肿瘤生长方式为胃癌患者的独立预后因素。术前动脉插管介入化疗和术后腹腔化疗对改善胃癌患者的预后具有重要价值。
Objective To explore the independent prognostic factors that affect the long-term survival of gastric cancer patients. Methods Fifteen clinical pathologies, treatment measures and molecular biological indexes that could affect the prognosis of gastric cancer patients were analyzed by Cox proportional hazards model. Multivariate regression analysis was performed. Results Univariate analysis showed that TNM classification, disease stage, tumor growth pattern, lymphatic vessel invasion, preoperative arterial intubation chemotherapy, postoperative intraperitoneal chemotherapy, CD44 splicing variant V6 (CD44V6) and E-cadherin CD) expression and PCNA labeling index (P <0.05) were significantly correlated with postoperative survival rate in gastric cancer patients (all P <0.05). Cox multivariate regression analysis showed that the prognostic factors of long-term survival of patients with gastric cancer were order of effect intensity, TNM classification, preoperative arterial intubation and chemotherapy, postoperative intraperitoneal chemotherapy and tumor growth pattern. Conclusion TNM classification, preoperative arterial intubation chemotherapy, postoperative intraperitoneal chemotherapy, tumor growth for gastric cancer patients with independent prognostic factors. Preoperative arterial catheterization chemotherapy and postoperative intraperitoneal chemotherapy for improving the prognosis of patients with gastric cancer is of great value.