Lauren分型在胃癌预后评估中的临床意义
Lauren분형재위암예후평고중적림상의의
Clinical significance of Lauren typing in the prognosis evaluation of gastric cancer
  • 万方数据
    中华消化杂志 중화소화잡지
    Chinese Journal of Digestion
    2014年 7期 449-452 ,共4页

    崔景利%梁寒%邓靖宇%丁学伟%潘源%张李%蔡明志%梁月祥%蒋楠

    최경리%량한%산정우%정학위%반원%장리%채명지%량월상%장남

    胃肿瘤%病理学,临床%预后 胃腫瘤%病理學,臨床%預後
    위종류%병이학,림상%예후
    Stomach neoplasms%Pathology,clinical%Prognosis
    目的 探讨Lauren分型在胃癌预后评估中的临床意义.方法 选取2003年6月至2007年6月无远处转移、接受胃癌根治术治疗、术后病理检查确诊、临床病理和随访资料完整的1 275例胃癌患者为研究对象.根据WHO分型,分为管状腺癌、乳头状腺癌、黏液腺癌和印戒细胞癌.根据Lauren分型,分为肠型和弥漫型.以患者死亡为随访终点,随访截止时间为2012年12月11日.采用Kaplan-Meier法计算各组生存率,采用Log-rank法进行显著性检验,以Cox模型进行生存分析.计量资料行t检验,计数资料行卡方检验.结果 在WHO分型中,780例胃管状腺癌、61例胃乳头状腺癌、216例胃黏液腺癌、218例印戒细胞癌患者的5年总体生存率分别为45.6％、42.7％、29.7％、35.7％,整体间比较差异有统计学意义(χ2=15.753,P＜0.01). 654例肠型和621例弥漫型胃癌患者的5年总体生存率分别为48.1％和33.7％,差异有统计学意义(χ2=26.723,P＜0.01).在810例胃癌淋巴结转移者中,404例肠型和406例弥漫型患者的5年总体生存率分别为34.1％和22.7％,差异有统计学意义(χ2=18.872,P＜0.01).在467例胃癌无淋巴结转移者中,252例肠型和215例弥漫型患者的5年总体生存率分别为69.1％和55.0％,差异有统计学意义(χ2=6.285,P＜0.05).在792例接受化学疗法治疗的胃癌患者中,394例肠型和398例弥漫型患者的5年总体生存率分别为53.2％和31.1％,差异有统计学意义(χ2=26.844,P＜0.05).在未接受化学疗法治疗的胃癌患者中,肠型和弥漫型患者的5年总体生存率差异无统计学意义(P＞0.05).在TNM Ⅰ期的胃癌患者中,肠型和弥漫型患者的5年总体生存率差异无统计学意义(P＞0.05).在393例TNMⅡ期患者中,212例肠型和181例弥漫型胃癌患者的5年总体生存率分别为64.3％和48.2％,差异有统计学意义(#=6.436,P＜0.05).在766例TNMⅢ期患者中,377例肠型和389例弥漫型胃癌患者的5年总体生存率分别为31.9％和21.5％,差异有统计学意义(χ2=15.518,P＜0.01).经Cox生存分析显示,Lauren分型为弥漫型是胃癌预后差的独立危险因素(回归系数=0.378,标准误=0.081,Wald值=21.839,风险比=1.460,95％CI为L 246～1.711,P＜0.01).结论 Lauren分型在胃癌预后评估中具临床意义,弥漫型胃癌患者的预后可能比肠型胃癌患者差.
    목적 탐토Lauren분형재위암예후평고중적림상의의.방법 선취2003년6월지2007년6월무원처전이、접수위암근치술치료、술후병리검사학진、림상병리화수방자료완정적1 275례위암환자위연구대상.근거WHO분형,분위관상선암、유두상선암、점액선암화인계세포암.근거Lauren분형,분위장형화미만형.이환자사망위수방종점,수방절지시간위2012년12월11일.채용Kaplan-Meier법계산각조생존솔,채용Log-rank법진행현저성검험,이Cox모형진행생존분석.계량자료행t검험,계수자료행잡방검험.결과 재WHO분형중,780례위관상선암、61례위유두상선암、216례위점액선암、218례인계세포암환자적5년총체생존솔분별위45.6％、42.7％、29.7％、35.7％,정체간비교차이유통계학의의(χ2=15.753,P＜0.01). 654례장형화621례미만형위암환자적5년총체생존솔분별위48.1％화33.7％,차이유통계학의의(χ2=26.723,P＜0.01).재810례위암림파결전이자중,404례장형화406례미만형환자적5년총체생존솔분별위34.1％화22.7％,차이유통계학의의(χ2=18.872,P＜0.01).재467례위암무림파결전이자중,252례장형화215례미만형환자적5년총체생존솔분별위69.1％화55.0％,차이유통계학의의(χ2=6.285,P＜0.05).재792례접수화학요법치료적위암환자중,394례장형화398례미만형환자적5년총체생존솔분별위53.2％화31.1％,차이유통계학의의(χ2=26.844,P＜0.05).재미접수화학요법치료적위암환자중,장형화미만형환자적5년총체생존솔차이무통계학의의(P＞0.05).재TNM Ⅰ기적위암환자중,장형화미만형환자적5년총체생존솔차이무통계학의의(P＞0.05).재393례TNMⅡ기환자중,212례장형화181례미만형위암환자적5년총체생존솔분별위64.3％화48.2％,차이유통계학의의(#=6.436,P＜0.05).재766례TNMⅢ기환자중,377례장형화389례미만형위암환자적5년총체생존솔분별위31.9％화21.5％,차이유통계학의의(χ2=15.518,P＜0.01).경Cox생존분석현시,Lauren분형위미만형시위암예후차적독립위험인소(회귀계수=0.378,표준오=0.081,Wald치=21.839,풍험비=1.460,95％CI위L 246～1.711,P＜0.01).결론 Lauren분형재위암예후평고중구림상의의,미만형위암환자적예후가능비장형위암환자차.
    Objective To explore the clinical significance of Lauren typing in the prognosis evaluation of gastric cancer.Methods From June 2003 to June 2007,1 275 patients with gastric cancer were selected as study objects,who received radical gastrectomy,and got the pathological diagnosis after surgery.The clinic-pathological and follow-up data of them were complete.According to World Health Organization (WHO) typing,gastric cancer was divided into tubular adenocarcinoma,papillary adenocarcinoma,mucinous adenocarcinoma and signet ring cell carcinoma.According to Lauren typing,it was divided into intestinal and diffuse type.The death of patient was regarded as the endpoint of the follow-up.The deadline of the follow-up was December 11,2012.The survival rate of each group was calculated by Kaplan-Meier method.The significance was tested with Log-rank method and survival analysis was analyzed with Cox model.Measurement data was analyzed by t test and chi-square test was for count data.Results According to WHO typing,the five year survival rate of 780 tubular adenocarcinoma,61 papillary adenocarcinoma,216 mucinous adenocarcinoma and 218 signet ring cell carcinoma was 45.6％,42.7％,29.7％ and 35.7％,respectively.In overall comparison,the difference was statistically significant (χ2 =15.753,P＜0.01).The five year survival rate of 654 intestinal type and 621 diffuse type gastric cancer was 48.1％ and 33.7 ％,the difference was statistically significant (χ2 =26.723,P＜0.01).Among 810 gastric cancer with lymph nodes metastasis,the five year survival rate of 404 intestinal type and 406 diffuse type was 34.1％ and 22.7％,the difference was statistically significant (χ2 =18.872,P＜0.01).Among 467 gastric cancer without lymph nodes metastasis,the five year survival rate of 252 intestinal type and 215 diffuse type was 69.1％ and 55.0％,the difference was statistically significant (χ2 =6a.285,P＜0.05).Among 792 patients with gastric cancer who received chemical therapy,the five year survival rate of 394 intestinal type and 398 diffuse type was 53.2％ and 31.1％,the difference was statistically significant (χ2 =26.844,P＜0.05).Among gastric cancer patients without chemical therapy,there was no significant difference in five year survival rate betwveen intestinal type and diffuse type (P＞0.05).Among patients at TNM stage Ⅰ,there was no significant difference in five year survival rate between intestinal type and diffuse type (P＞0.05).Among 393 patients at TNM stage Ⅱ,the five year survival rate of 212 intestinal type and 181 diffuse type was 64.3％ and 48.2％,the difference was statistically significant (χ2 =6.436,P＜0.05).Among 766 patients atTNM stage]Ⅲ,the five year snrvival rate of 377 intestinal type and 389 diffuse type was 31.9％ and 21.5％,the difference was statistically significant (χ2=15.518,P＜0.01).The results of Cox survival analysis indicated that in Lauren typing diffuse type was an independent risk factor of poor prognosis in gastric cancer (regression coefficients 0.378,standard error 0.081,Wald 21.839,hazard ratio 1.460,95％ CI 1.246 to 1.711,P＜0.01).Conclusion Lauren classification has clinical significance in the prognosis evaluation of gastric cancer.Diffuse type adenocarcinoma may carry a worse prognosis than intestinal type.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문