摘要
目的探讨不同手术治疗策略对初始可切除型胃癌肝转移患者预后的影响。方法本研究为回顾性队列研究。选取2010年1月至2019年12月胃癌肝转移全国多中心回顾性队列研究数据库中282例接受手术治疗的初始可切除型患者的临床病理学资料;男性231例,女性51例,年龄[M(IQR)]61(14)岁(范围:27~80岁)。根据外科治疗决策将患者分为根治组和姑息组。采用Kaplan-Meier法绘制不同治疗组的生存曲线,Log-rank检验比较生存率差异。应用Cox比例风险回归模型评估各种因素的HR,通过多因素分析控制混杂因素,评估不同手术策略对初始可切除型胃癌肝转移患者预后的影响。采用限制性立方样条Cox比例风险模型,评估并描述定量资料与预后间的详细关系。引入X-tile作为辅助工具,确定定量资料在患者生存分析中的关键阈值。最后应用分层分析筛选不同手术治疗方式的潜在获益人群。结果(1)282例患者中,根治组118例,均完成原发灶和转移灶的R0切除或局部物理治疗;姑息组164例,包括胃原发肿瘤和肝转移瘤姑息性切除52例,仅胃原发肿瘤的根治性切除56例,胃原发肿瘤的姑息性切除45例,肝转移瘤姑息性治疗11例。两组患者的肝转移瘤位置和数目有明显差异(P值均<0.05)。(2)282例患者中位总体生存期为22.7个月(95%CI:17.8~27.6个月),1年和3年总体生存率分别为65.4%和35.6%。根治组和姑息组患者的1年总体生存率分别为68.3%和63.1%,3年总体生存率分别为42.2%和29.9%(P=0.254)。与其他手术方案相比,仅行姑息性胃癌切除术的患者预后最差(HR=1.98,95%CI:1.21~3.24,P=0.006)。(3)胃原发肿瘤最大径是独立预后因素(HR=2.01,95%CI:1.45~2.79,P<0.01),肿瘤越大,HR越高。(4)根治性治疗较姑息性治疗,在高-中分化肿瘤(HR=2.84,95%CI:1.49~5.41,P=0.001)和肝转移瘤位于左半肝(HR=2.06,95%CI:1.19~3.57,P=0.010)的患者中可以取得更好的预后。结论在初始可切�
Objective To examine the impact of varied surgical treatment strategies on the prognosis of patients with initial resectable gastric cancer liver metastases(IR-GCLM).Methods This is a retrospective cohort study.Employing a retrospective cohort design,the study selected clinicopathological data from the national multi-center retrospective cohort study database,focusing on 282 patients with IR-GCLM who underwent surgical intervention between January 2010 and December 2019.There were 231 males and 51 males,aging(M(IQR))61(14)years(range:27 to 80 years).These patients were stratified into radical and palliative treatment groups based on treatment decisions.Survival curves were generated using the Kaplan-Meier method and distinctions in survival rates were assessed using the Log-rank test.The Cox risk regression model evaluated HR for various factors,controlling for confounders through multivariate analysis to comprehensively evaluate the influence of surgery on the prognosis of IR-GCLM patients.A restricted cubic spline Cox proportional hazard model assessed and delineated intricate associations between measured variables and prognosis.At the same time,the X-tile served as an auxiliary tool to identify critical thresholds in the survival analysis for IR-GCLM patients.Subgroup analysis was then conducted to identify potential beneficiary populations in different surgical treatments.Results(1)The radical group comprised 118 patients,all undergoing R0 resection or local physical therapy of primary and metastatic lesions.The palliative group comprised 164 patients,with 52 cases undergoing palliative resections for gastric primary tumors and liver metastases,56 cases undergoing radical resections for gastric primary tumors only,45 cases undergoing palliative resections for gastric primary tumors,and 11 cases receiving palliative treatments for liver metastases.A statistically significant distinction was observed between the groups regarding the site and the number of liver metastases(both P<0.05).(2)The median overall sur
作者
李力
高云鹤
臧潞
薛侃
柯彬
商亮
唐兆庆
余江
梁延锐
何子锐
郑华龙
黄华
熊建平
何中原
李佶阳
卢婷婷
宋奇赢
刘诗贺
陈亚文
唐云
梁寒
乔治
陈凛
Li Li;Gao Yunhe;Zang Lu;Xue Kan;Ke Bin;Shang Liang;Tang Zhaoqing;Yu Jiang;Liang Yanrui;He Zirui;Zheng Hualong;Huang Hua;Xiong Jianping;He Zhongyuan;Li Jiyang;Lu Tingting;Song Qiying;Liu Shihe;Chen Yawen;Tang Yun;Liang Han;Qiao Zhi;Chen Lin(Graduate School,Chinese People′s Liberation Army Medical School,Beijing 100853,China;Senior Department of General Surgery,the First Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100853,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Gastrointestinal Surgery,Peking University Cancer Hospital,Beijing 100142,China;Department of Gastric Cancer,Tianjin Medical University Cancer Institute and Hospital,Tianjing 300060,China;Department of Gastrointestinal Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Gastric Cancer,Union Hospital,Fujian Medical University,Fuzhou,350001,China;Department of Gastric Cancer,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Pancreatic and Gastric Surgery,Cancer Hospital,Chinese Academy of Medical Scicence,Beijing 100021,China;Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Gastrointestinal Surgery,Peking University International Hospital,Beijing 100871,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2024年第5期370-378,共9页
Chinese Journal of Surgery
基金
国家自然科学基金(81972790)
军队后勤科研项目(145BHQ090003000X08)
军队装备综合研究计划(LB2022B020200-QZ)。
关键词
胃肿瘤
肿瘤转移
手术治疗
胃癌肝转移
预后
Stomach neoplasms
Neoplasm metastasis
Surgical treatment
Gastric cancer liver metastases
Prognosis
