Li Fengke, Wang Yimin, Li Chunfeng, Ma Yan, Zhang Yongle, Li Zhiguo, Xue Yingwei
Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 May 25;21(5):529-534.
To compare clinicopathological features and prognosis between patients with carcinoma in the remnant stomach (CRS) and with gastric cancer, and to investigate the prognostic factors in CRS patients.
A retrospective cohort study was performed on clinicopathological data of 96 CRS patients (CRS group) and selected 440 patients with gastric cancer (GC group) treated at Harbin Medical University Cancer Hospital from January 1977 to December 2017.
(1) undergoing gastrectomy; (2) diagnosed with CRS or gastric cancer through electronic gastroscopies and pathology; (3) without preoperative neoadjuvant radiotherapy or chemotherapy; (4) complete clinicopathological and follow-up data. The patients who died of other reasons or were lost during follow-up were excluded. Chi-square test and independent samples t-test were used to determine differences in clinicopathological factors between two groups. Survival analysis was conducted using the Kaplan-Meier method, and Log-rank test was used to compare survival difference between two groups. The prognosis of CRS patients was analyzed using Cox proportional hazards regression model.
As compared to GC group, CRS group had a higher proportion of female [30.2%(29/96) vs. 13.2%(58/ 440), χ=14.095, P=0.000], younger age [(56.4±10.1) years vs. (60.0±9.9) years, t=2.838, P=0.005], more distant metastasis and local organ infiltration [25.0%(24/96) vs. 16.1%(71/440), χ=4.246, P=0.039; 64.6% (62/96) vs. 24.5% (108/440), χ=58.331, P=0.000], lower prognostic nutritional index [(48.0±6.7) vs. (50.4±6.9), t=3.093, P=0.002], lower serum hemoglobin level [(115.0±24.7) g/L vs. (127.9±24.6) g/L, t=4.634, P=0.000], lower serum albumin level [(40.0±4.9) g/L vs. (41.2±5.0) g/L, t=2.038, P=0.042], and earlier occurrence of symptoms [(1.9±1.4) months vs. (3.7±3.2) months, t=5.431, P=0.000]. However, there were no statistically significant differences in TNM staging, postoperative hospital stay, and total hospitalization days between the two groups (all P>0.05). During follow-up, 24(25.0%) patients developed recurrence or distant metastasis and 68 (70.8%) patients died of tumor progression in CRS group, while 71(16.1%) patients developed recurrence or distant metastasis and 378(85.9%) patients died of tumor progression in GC group. The 5-year survival rate of CRS patients was 23.4%, which was higher than 15.0% of gastric cancer patients (P=0.032). Univariate analysis showed that the CRS patients with radical operation (P=0.000), earlier TNM stage (P=0.000), non-distant metastasis (P=0.022), serum hemoglobin level >130 g/L(P=0.013), and serum album level >40 g/L (P=0.042) had better prognosis. Multivariate analysis, enrolling above 5 factors, showed that TNM staging (HR=2.363, 95%CI: 1.478-3.776, P=0.000) and serum hemoglobin level >130 g/L(HR=0.449, 95%CI: 0.244-0.827, P=0.010) were independent factors influencing prognosis of CRS patients.
Although CRS patients have better prognosis than gastric cancer patients, but local organ invasion and distant metastasis occurs more readily. TNM staging and serum hemoglobin level are independent prognostic factors for CRS patients.
比较残胃癌（CRS）患者与胃癌患者的临床病理特征及预后，并探讨CRS患者的预后因素。
对哈尔滨医科大学附属肿瘤医院1977年1月至2017年12月收治的96例CRS患者（CRS组）的临床病理资料进行回顾性队列研究，并选取440例胃癌患者（GC组）。
（1）接受过胃切除术；（2）经电子胃镜及病理诊断为CRS或胃癌；（3）术前未接受新辅助放疗或化疗；（4）有完整的临床病理及随访资料。排除因其他原因死亡或随访期间失访的患者。采用卡方检验和独立样本t检验确定两组临床病理因素的差异。采用Kaplan-Meier法进行生存分析，采用Log-rank检验比较两组生存差异。采用Cox比例风险回归模型分析CRS患者的预后。
与GC组相比，CRS组女性比例更高[30.2%（29/96）对13.2%（58/440），χ=14.095，P=0.000]，年龄更小[（56.4±10.1）岁对（60.0±9.9）岁，t=2.838，P=0.005]，远处转移和局部器官浸润更多[25.0%（24/96）对16.1%（71/440），χ=4.246，P=0.039；64.6%（62/96）对24.5%（108/440），χ=58.331，P=0.000]，预后营养指数更低[（48.0±6.7）对（50.4±6.9），t=3.093，P=0.002]，血清血红蛋白水平更低[（115.0±24.7）g/L对（127.9±24.6）g/L，t=4.634，P=0.000]，血清白蛋白水平更低[（40.0±4.9）g/L对（41.2±5.0）g/L，t=2.038，P=0.042]，症状出现更早[（1.9±1.4）个月对（3.7±3.2）个月，t=5.431，P=0.000]。然而，两组在TNM分期、术后住院时间和总住院天数方面差异无统计学意义（均P>0.05）。随访期间，CRS组24例（25.0%）患者出现复发或远处转移，68例（70.8%）患者死于肿瘤进展，而GC组71例（16.1%）患者出现复发或远处转移，378例（85.9%）患者死于肿瘤进展。CRS患者的5年生存率为23.4%，高于胃癌患者的15.0%（P=0.032）。单因素分析显示，行根治性手术（P=0.000）、TNM分期较早（P=0.000）、无远处转移（P=0.022）、血清血红蛋白水平>130 g/L（P=0.013）和血清白蛋白水平>40 g/L（P=0.042）的CRS患者预后较好。多因素分析纳入上述5个因素，显示TNM分期（HR=2.363，95%CI：1.478-3.776，P=0.000）和血清血红蛋白水平>130 g/L（HR=0.449，95%CI：0.244-0.827，P=0.010）是影响CRS患者预后的独立因素。
尽管CRS患者的预后优于胃癌患者，但局部器官侵犯和远处转移更容易发生。TNM分期和血清血红蛋白水平是CRS患者的独立预后因素。
