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胃癌根治术中切缘肿瘤残留危险因素的分析

Risk factors of resection-margin involvement in radical gastrectomy of gastric cancer patients

  • 摘要: 目的:明确胃癌根治术(D2)中切缘(resectionmargins,RM)肿瘤残留(R1)发生的独立危险因素。方法:回顾性分析2008年1月至2009年11月长海医院普通外科收治的412例行胃癌根治术患者资料。对影响上切缘(proximalresectionmargins,PRM)/下切缘(distalresectionmargins,DRM)R1发生的相关因素进行单因素分析及Logistic多因素回归分析。利用ROC曲线评估PRM/DRM距离预测PRM/DRMR0的价值。结果:单因素分析显示,影响PRMR1发生的因素包括肿瘤大小、肿瘤部位、Borrmann分型、血清肿瘤标志物、手术方式、PRM距离、T分期、N分期及TNM分期(均P<0.05);影响DRMR1发生的因素包括DRM距离、T分期及肿瘤浸润血管(均P<0.05)。多因素分析显示,N3(RR=2.677)和PRM距离(RR=0.423)是PRMR1发生的危险因素;DRM距离(RR=0.407)是DRMR1发生的危险因素。PRM距离用于预测PRMR0最佳界值为2.05cm(敏感性为79.9%,特异性为75.0%)。DRM距离用于预测DRMR0最佳界值为1.65cm(敏感性为88.6%,特异性为66.7%)。结论:N3期和PRM距离是PRMR1发生的独立危险因素,DRM距离是DRMR1发生的唯一独立危险因素。PRM/DRM距离最佳界值可用于指导实现RMR0。

     

    Abstract: Objective:To investigate the risk factors of resection-margin involvement(R1)in radical gastrectomy of gastric cancer patients. Methods:The clinical data of 412 cases of radical gastrectomy performed from Jan.2008 to Nov.2009 in Changhai Hospital were analyzed retrospectively. The potential risk factors of proximal resection margins(PRM)/distal resection margins(DRM)R1 were analyzed by univariate and multivariate Logistic regression analysis. Results:The univariate analysis showed that the risk factors of PRM R1 included tumor size,tumor location, Borrmann type,tumor marker in serum,Operation name,PRM distance,T stage,N stage and TNM stage(P<0.05), and the risk factors of DRM R1 included DRM distance, T stage and vascular invasion(P<0.05). The multivariate Logistic regression analysis showed that the risk factors of PRM R1 included N3(RR=2.677)and PRM distance(RR=0.423),and the risk factors of DRM R1 was DRM distance (RR=0.407).There were no effect on the PRM R1 when PRM distance ≥9cm and on the DRM R1 when DRM distance ≥4cm under the analysis of RM distance as intercept point. Conclusion:N3 stage and PRM distance(<9cm)are independent risk factors of the incidence of PRM R1 and DRM distance(<4cm)is the only independent risk factors of the incidence of DRM R1.

     

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