胃癌长期生存的预后因素。引入新的N+/T指数

Q4 Medicine

Revista Chilena De Cirugia Pub Date : 2018-04-19 DOI:10.4067/S0718-40262018000200147

Manuel Figueroa-Giralt

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引用次数: 4

摘要

背景:胃癌生存预后因素的确定，使我们能够制定临床指南。智利在长期生存预后因素分析方面存在缺陷。目的:探讨影响胃癌长期生存的各种预后因素。确定胃切除术后5年和10年的生存率，以及一个新的长期生存预后因素N+/T的价值。材料与方法:对智利大学临床医院2004年5月至2012年5月肿瘤数据库进行前瞻性研究。结果:共纳入284例患者，男性占65.4%，平均年龄64.5岁。75%为晚期胃癌，72.5%的患者需要全胃切除术。85.2%行淋巴结清扫，平均淋巴结清扫30个。术后发病率和死亡率分别为17.2%和1.7%。总体平均生存期为69.9个月，5年生存期为56.9%，10年生存期为53.4%。N+/T指数在所有亚组的总体生存率上有统计学意义(p < 0.0001)。多因素分析显示:N+/T指数(p = 0.0001, OR: 1.1[1.05-1.12])、LNR (p = 0.0001, OR: 5.8[1.04-15.6])、年龄(p = 0.008, OR: 1.03[1.00-1.06])、淋巴血管渗透(p = 0.0001, OR: 2.19[1.49-3.23])、T分类(p = 0.03, OR: 3.4[1.10-8.93])、N分类(p = 0.001, OR: 1.06[1.01-1.06])、TNM分期(p = 0.004, OR: 1.03[1.01-1.06])。N+/T、LNR和T分类的ROC曲线下面积分别为0.789、0.786和0.790 (p = 0.96)。结论:影响长期生存的独立预后因素有N+/T指数、LNR、年龄、淋巴血管渗透、T分型、N分型和TNM分期。与此同时，一种新的预后因子N+/T指数也被用来评估胃癌患者的生存。

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Factores pronósticos de sobrevida alejada en cáncer gástrico. Introducción del nuevo índice N+/T

Background: The identification of survival prognostic factors for gastric cancer, allows us to create clinical guidelines. Chile has a deficit in the analysis of long-term survival prognostic factors. Aim: To assess different prognostic factors of long-term survival in gastric cancer. Determine the survival rate at 5 and 10-years post gastrectomy, and the value of a new prognostic factor of long-term survival called N+/T. Material and Method: Prospective study of the oncological database of the Clinical Hospital of the University of Chile between May 2004 and May 2012. Results: A total of 284 patients were included, 65.4% were men and the mean age was 64.5 years. Seventy-five percent were advanced gastric cancer, 72.5% of the patients required a total gastrectomy. The lymphadenectomy practiced was D2 in 85.2%, and average lymph node harvest was 30 lymph nodes. The postoperative morbidity and mortality was 17.2% and 1.7% respectively. The average global survival was 69.9 months, the 5-year survival was 56.9% and the 10-year survival was 53.4%. The N+/T index presented a statistically significant difference in the global survival of all the subgroups (p < 0.0001). The multivariate analysis showed that the significant variables were: N+/T index (p = 0.0001, OR: 1.1 [1.05-1.12]), LNR (p = 0.0001, OR: 5.8 [1.04-15.6]), age (p = 0.008, OR: 1.03 [1.00-1.06]), lymphovascular permeation (p = 0.0001, OR: 2.19 [1.49-3.23]), T classification (p = 0.03, OR: 3.4 [1.10-8.93]), N classification(p = 0.001, OR: 1.06 [1.02-1.10]), and TNM stage (p = 0.004, OR: 1.03 [1.01-1.06]). The areas under the ROC curves of the N+/T, LNR and T classification, were 0.789, 0.786 and 0.790 respectively (p = 0.96). Conclusion: The independent prognostic factors of long-term survival were N+/T index, LNR, age, lymphovascular permeation, T classification, N classification and TNM stage. Concomitantly, a new prognostic factor has been created to assess survival in gastric cancer, the N+/T index.

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来源期刊

Revista Chilena De Cirugia Medicine-Surgery

CiteScore

0.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： La Revista Chilena de Cirugía es un órgano de difusión del conocimiento y actividad quirúrgica. Su población objetivo son cirujanos, especialistas de otras áreas médicas, médicos generales y alumnos del área de la salud. Sirve a cirujanos y otros especialistas, para publicar artículos originales e inéditos sobre temas médicos, en particular artículos de investigación básica y clínica, artículos de revisión, entre otros. Buscan difundir y actualizar el conocimiento médico general y quirúrgico en particular. Se publica en forma bimestral. La Revista Chilena de Cirugía está afiliada y patrocinada por la Sociedad de Cirujanos de Chilese desde el año 1952.