CAJ | 학술논문

目的探讨进展期胃癌根治术后复发患者的临床资料和预后情况.方法对进展期胃癌根治术后复发的147例患者进行回顾性研究,对复发的相关因素进行单因素和多因素Logistic回归分析,对预后的相关因素采用单因素Kaplan-Meier及多因素COX回归模型分析.结果本组患者早期复发86例(距首次手术≤1年),晚期复发61例(距首次手术＞1年).两组患者的临床资料、肿瘤直径、Borrmann分型、手术方式、T分期、N分期、TNM分期之间相比差异均有统计学意义(均P＜0.05).多因素Logistic回归分析显示,TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素(P＜0.05).单因素分析结果显示,胃癌术后化疗(P＜0.05)、T分期(P＜0.05)、N分期(P＜0.01)、TNM分期(P＜0.01)、复发时间(P＜0.01)和再手术(P＜0.01)是影响复发患者预后的主要因素;多因素分析结果显示,TNM分期(P＜0.01)、复发时间(P＜0.05)和再手术(P＜0.01)是复发患者的独立预后影响因素.结论 TNM分期和N分期是进展期胃癌术后早期复发的独立危险因素.胃癌术后复发患者的预后较差,积极行再手术治疗有助于延长患者的生存时间.
목적 탐토진전기위암근치술후복발환자적림상자료화예후정황.방법 대진전기위암근치술후복발적147례환자진행회고성연구,대복발적상관인소진행단인소화다인소Logistic회귀분석,대예후적상관인소채용단인소Kaplan-Meier급다인소COX회귀모형분석.결과 본조환자조기복발86례(거수차수술≤1년),만기복발61례(거수차수술＞1년).량조환자적림상자료、종류직경、Borrmann분형、수술방식、T분기、N분기、TNM분기지간상비차이균유통계학의의(균P＜0.05).다인소Logistic회귀분석현시,TNM분기화N분기시진전기위암술후조기복발적독립위험인소(P＜0.05).단인소분석결과 현시,위암술후화료(P＜0.05)、T분기(P＜0.05)、N분기(P＜0.01)、TNM분기(P＜0.01)、복발시간(P＜0.01)화재수술(P＜0.01)시영향복발환자예후적주요인소;다인소분석결과 현시,TNM분기(P＜0.01)、복발시간(P＜0.05)화재수술(P＜0.01)시복발환자적독립예후영향인소.결론 TNM분기화N분기시진전기위암술후조기복발적독립위험인소.위암술후복발환자적예후교차,적겁행재수술치료유조우연장환자적생존시간.
Objective To investigate the clinical features and prognosis of recurrent gastric cancer. Methods The clinical data of 147 patients with recurrent gastric cancer was reviewed. Risk factors correlated with tumor recurrence and recurrent intervals were studied by logistic regression analysis. Survival analyses and comparisons were performed using Kaplan-Meier plots, the log rank test and the Cox proportional hazards model. Results Patients were divided into an "early recurrence group" consisting of 86 patients (recurred within one year after surgery) and a "late recurrence group" of 61 patients (recurred one year or more after surgery). There were significant difference in size of primary tumor, Borrmann stage, type of gastrectomy, T stage, N stage, TNM stage between the two groups(P ＜0.05). Multivariate analysis showed that the TNM stage and N stage independently influenced the recurrent time ( P ＜ 0. 05 ). In univariate survival analysis, post-gastrectomy chemotherapy(P ＜0. 05) , T stage (P ＜0. 05) , N stage(P ＜0.01) , TNM stage ( P ＜ 0. 01) , recurrence-free interval (P ＜ 0. 01) and reoperation (P ＜ 0.01) were significantly correlated with the prognosis. In multivariable analysis, TNM stage(P ＜0. 01) , recurrence-free interval ( P ＜ 0. 05 ) and reoperation ( P ＜ 0. 05 ) were independent factors predicting recurrence. Conclusions The TNM stage and N stage were the important factors predicting the time of recurrence after curative resection for gastric cancer. Patients with recurrent gastric cancer have poor prognosis and reoperation was associated with an improved survival in patients with recurrent gastric cancer.