胃癌根治术后早期复发转移的危险因素分析

doi:10.19401/j.cnki.1007-3639.2022.07.002

中国癌症杂志 ›› 2022, Vol. 32 ›› Issue (7): 588-595.doi: 10.19401/j.cnki.1007-3639.2022.07.002

胃癌根治术后早期复发转移的危险因素分析

曹孟轩¹^,²()(), 胡灿¹, 张延强¹, 黄灵¹, 杜义安¹, 于鹏程¹^,³, 章若岚¹^,⁴, 徐志远¹()(), 程向东¹()()

1.中国科学院大学附属肿瘤医院（浙江省肿瘤医院）胃外科,中国科学院基础医学与肿瘤研究所,浙江杭州 310005
2.温州医科大学,浙江省肿瘤医院研究生培养基地,浙江温州 325035
3.浙江中医药大学第一临床医学院,浙江杭州 310053
4.浙江中医药大学第二临床医学院,浙江杭州 310053

收稿日期:2022-06-02 出版日期:2022-07-30 发布日期:2022-08-09
通信作者: 徐志远,程向东 E-mail:mengxuan00001@126.com;xuzy@zjcc.org.cn;chengxd@zjcc.org.cn
作者简介:曹孟轩（ORCID: 0000-0003-3805-324X）,硕士在读,E-mail: mengxuan00001@126.com。
程向东,教授,主任医师,博士研究生导师。现任中国科学院大学附属肿瘤医院（浙江省肿瘤医院）党委书记,浙江省上消化道肿瘤防控与诊治重点实验室主任,肿瘤分子诊断与智能筛查浙江省国际科技合作基地负责人,消化道肿瘤诊治创新技术浙江省工程研究中心主任,浙江省消化道肿瘤临床医学研究中心主任,浙江省上消化道肿瘤诊治技术研究中心主任。兼任中国医师协会外科医师分会肿瘤外科医师委员会副主任委员,中国抗癌协会胃癌专业委员会副主任委员,中华医学会外科学分会胃肠外科学组常务委员,浙江省抗癌协会肿瘤微创诊治专业委员会主任委员,浙江省医师协会肿瘤MDT专业委员会主任委员,浙江省中西医结合学会副会长,浙江省医学会外科学分会副主任委员,浙江肿瘤联盟胃癌专业委员会主任委员等。作为浙江省胃癌诊治领域的学科带头人,擅长开展开腹和腹腔镜微创胃癌根治术,曾连续3年获全国手术比赛第1名,多次在胃癌国际会议上进行演讲和现场手术演示;善于技术创新,自主设计新型Kissing式胰肠吻合术,使Whipple术后胰瘘和消化道出血率低于2%;创新开展累及幽门胃癌D2+淋巴结清扫术,提高根治度,降低复发风险;开创性提出经腹进胸胃食管结合部癌的手术方式及重建方式;创新性提出程氏“三步法”胃癌胃大弯区淋巴结清扫术等。国内最早开展晚期胃癌转化治疗研究,在亚洲临床肿瘤学联盟研究（CONVO-GC-1）中提供的数据居全球第3,国内第1;开展了6项相关临床研究,其中Ahead-G325研究结果入选2017年美国临床肿瘤学会胃肠肿瘤研讨会大会交流,并为2018版中国临床肿瘤学会官方指南更新贡献临床指导依据;胃癌腹膜种植转移外科治疗技术全国领先,省内最早引进术中腹腔热灌注化疗方法,率先提出腹腔化疗-手术-热疗-化疗的模式治疗腹膜转移性胃癌和卵巢切除-化疗-手术-化疗的胃癌卵巢种植治疗模式,牵头制定《胃癌卵巢转移诊断和治疗中国专家共识（2021版）》。近年来,在胃癌诊治方法、转化治疗、胃癌上皮-间充质转化发生机制、胃癌生物标志物筛选和老年胃癌患者综合治疗方面均取得了一系列重大突破和创新,作为首席科学家牵头“十四五”科技部国家重点研发计划,牵头国家“十三五”重大疑难疾病（胃癌）中西医临床协作试点项目,获得10多项国家级、省级和厅级重点项目和专项资助,累计科研经费达5 000万以上,在Molecular Cancer、Drug Resistance Updates、Cell Communication and Signaling、Journal of Natural Products等国际知名学术刊物上发表论文100多篇,其中在SCI收录期刊上发表50多篇,出版专著2部,获得国家发明专利2项、软件著作权2项,作为第一完成人获得浙江省科学技术进步三等奖1项、浙江省中医药科学技术一等奖2项和三等奖1项。
基金资助:
国家自然科学基金(82074245);国家自然科学基金(81973634)

Analysis of risk factors of early recurrence and metastasis after radical resection of gastric cancer

CAO Mengxuan¹^,²()(), HU Can¹, ZHANG Yanqiang¹, HUANG Ling¹, DU Yian¹, YU Pengcheng¹^,³, ZHANG Ruolan¹^,⁴, XU Zhiyuan¹()(), CHENG Xiangdong¹()()

1. Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Department of Gastric Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310005, Zhejiang Province, China
2. Postgraduate Training Base of Zhejiang Cancer Hospital, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
3. The First Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310053, Zhejiang Province, China
4. The Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou 310053, Zhejiang Province, China

Received:2022-06-02 Published:2022-07-30 Online:2022-08-09
Contact: XU Zhiyuan, CHENG Xiangdong E-mail:mengxuan00001@126.com;xuzy@zjcc.org.cn;chengxd@zjcc.org.cn

摘要/Abstract

摘要：

背景与目的： 目前胃癌仍是癌症死亡的重要原因,其术后复发是导致胃癌患者生存率较低的主要因素。本研究旨在探讨胃癌患者术后早期、晚期复发转移与临床病理学特征的关系,以便更好地改善胃癌预后。方法： 回顾性分析2014年1月—2016年1月在浙江省肿瘤医院行胃癌根治性手术后出现复发转移的188例胃癌患者的临床病理学资料,比较早期复发转移患者（≤2年）与晚期复发转移患者（>2年）的临床病理学特征的差异。结果： 188例患者中,126例患者出现早期复发,62例患者出现晚期复发,总体中位复发时间为术后18个月。复发部位、淋巴结转移、浆膜浸润、无术前新辅助化疗、无术后辅助化疗及低分化是胃癌术后早期复发的独立危险因素。结论： 复发部位、术前新辅助化疗、术后辅助化疗、淋巴结转移、浸润深度及组织分化程度与术后复发有关。

关键词: 胃癌, 术后复发, 危险因素, 预后

Abstract:

Background and purpose: At present, gastric cancer is still an important cause of cancer death, and its postoperative recurrence is the main factor leading to the low survival rate of gastric cancer. The purpose of this study was to investigate the relationship between early and late postoperative recurrence and metastasis and clinicopathological features in patients with gastric cancer in order to improve the prognosis of gastric cancer. Methods: The clinicopathological data of 188 patients with recurrent and metastatic gastric cancer after radical operation in Zhejiang Cancer Hospital from January 2014 to January 2016 were analyzed retrospectively. The clinicopathological characteristics of patients with early recurrence and metastasis (≤2 years) and late recurrence and metastasis (>2 years) were compared. Results: Among the 188 patients, 126 patients had early recurrence and 62 patients had late recurrence. The overall median time of recurrence was 18 months after operation. Recurrence site, lymph node metastasis, serosa infiltration, no preoperative neoadjuvant chemotherapy, no postoperative adjuvant chemotherapy and poor differentiation are independent risk factors for early postoperative recurrence of gastric cancer. Conclusion: The location of recurrence, preoperative neoadjuvant chemotherapy, postoperative adjuvant chemotherapy, lymph node metastasis, depth of invasion and degree of tissue differentiation are related to postoperative recurrence.

Key words: Gastric cancer, Postoperative recurrence, Risk factors, Prognosis

中图分类号:

R735.2

曹孟轩, 胡灿, 张延强, 黄灵, 杜义安, 于鹏程, 章若岚, 徐志远, 程向东. 胃癌根治术后早期复发转移的危险因素分析[J]. 中国癌症杂志, 2022, 32(7): 588-595.

CAO Mengxuan, HU Can, ZHANG Yanqiang, HUANG Ling, DU Yian, YU Pengcheng, ZHANG Ruolan, XU Zhiyuan, CHENG Xiangdong. Analysis of risk factors of early recurrence and metastasis after radical resection of gastric cancer[J]. China Oncology, 2022, 32(7): 588-595.

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参考文献 32

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Data	Case n	Data	Case n
Gender		Body	48
Male	136	Antrum	94
Female	52	Cardiac	43
Age/year		Full	3
≥60	99	Borrmann type
<60	89	Ⅰ	4
Chronic illness		Ⅱ	102
Yes	54	Ⅲ	52
No	134	Ⅳ	30
Drinking history		Site of recurrence
Yes	64	Liver	30
No	124	Abdominal	95
Smoking history		Other mode	63
Yes	88	Lymph node metastasis
No	100	N₀	26
Preoperative chemotherapy		N₁	20
Yes	53	N₂	40
No	135	N₃	102
Postoperative chemotherapy		Vascular tumor thrombus
Yes	148	Positive	117
No	40	Negative	71
Reconstruction		Nerve infiltration
Billroth Ⅰ	67	Positive	137
Billroth Ⅱ	21	Negative	51
Roux-en-Y	100	Serosa infiltration
Tumor length/cm		Positive	152
≥3	168	Negative	36
<3	20	Number of lymph nodes
Signet-ring cell carcinoma		>12	51
Yes	79	≤12	137
No	109	cTNM stage
Differentiated degree		Ⅰ	4
Low-medium	115	Ⅱ	31
Medium-high	73	Ⅲ	148
Primary site		Ⅳ	5

Data	Early recurrence (n=126)	Late recurrence (n=62)	χ²	P value
Age/year
≥60	68	31	0.262	0.608
<60	58	31	0.262	0.608
Gender
Male	97	39	4.118	0.042
Female	29	23	4.118	0.042
Reconstruction
Billroth Ⅰ	37	30	6.607	0.037
Billroth Ⅱ	15	6
Roux-en-Y	74	26
Serosa infiltration
Positive	114	38	22.862	0.000
Negative	12	24	22.862	0.000
Preoperative chemotherapy
Yes	27	26	8.632	0.003
No	99	36	8.632	0.003
Tumor length/cm
≥3	118	50	7.393	0.007
<3	8	12	7.393	0.007
Site of recurrence
Liver	27	3	8.561	0.014
Abdominal	59	36
Other mode	40	23
Number of lymph nodes
>12	42	9	7.443	0.006
≤12	84	53	7.443	0.006
Differentiated degree
Low-medium	87	28	9.982	0.002
Medium-high	39	34	9.982	0.002

Data	P value (univariate)	HR (multivariate)	95% CI (multivariate)	P value (multivariate)
Age/year
≥60	0.532
<60	0.532
Gender
Male	0.217
Female	0.217
Preoperative chemotherapy
Yes	0.000	0.467	0.313-0.699	0.000
No	0.000	0.467	0.313-0.699	0.000
Postoperative chemotherapy
Yes	0.047	0.692	0.492-0.973	0.034
No	0.047	0.692	0.492-0.973	0.034
Tumor length/cm
≥3	0.033	1.460	0.905-2.355	0.121
<3	0.033	1.460	0.905-2.355	0.121
Number of lymph nodes
>12	0.001	1.886	1.313-2.709	0.001
≤12	0.001	1.886	1.313-2.709	0.001
Signet-ring cell carcinoma
Yes	0.626
No	0.626
Primary site
Body	0.105
Antrum
Cardiac
Full
Serosa infiltration
Positive	0.000	2.047	1.333-3.144	0.001
Negative	0.000	2.047	1.333-3.144	0.001
Nerve infiltration
Positive	0.020	0.802	0.557-1.155	0.236
Negative	0.020	0.802	0.557-1.155	0.236
Site of recurrence
Liver	0.030	1.290	1.006-1.654	0.045
Abdominal
Other mode
Differentiated degree
Low-medium	0.000	1.475	1.068-2.037	0.018
Medium-high	0.000	1.475	1.068-2.037	0.018
Vascular tumor thrombus
Positive	0.187
Negative	0.187

胃癌根治术后早期复发转移的危险因素分析

Analysis of risk factors of early recurrence and metastasis after radical resection of gastric cancer

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