Ma Xiaoming, Zhou Wei, Wang Cheng, Miao Wei, Liu Ning, Wang Shigui, Guan Shihao
Department of Gastrointestinal Tumor Surgery, the Affiliated Hospital of Qinghai University, Xining, China.
Medicine (Baltimore). 2018 Nov;97(45):e13017. doi: 10.1097/MD.0000000000013017.
The incidences of upper third gastric cancer (UTGC) have been increasing. However, the prognostic factors for UTGC following radical surgical treatment remains largely unknown. This study was to investigate prognostic factors for overall survival (OS), lymph node metastasis and recurrence of UTGC.Clinicopathologic data of 126 UTGC patients who underwent radical surgical treatment were retrospectively analyzed. OS and univariate analysis were determined by Kaplan-Meier analysis and the significance of the difference between curves was calculated with the log-rank test. The Cox proportional hazards regression model was applied to perform multivariate analysis. Receiver operating characteristic (ROC) curve analysis was used to determine the prognostic accuracy.The 1-, 3-, and 5-year OS for patients with UTGC were 81%, 47.6%, and 38.6% respectively. Univariate analysis showed that tumor size (P = .019), tumor invasion depth (P < .001), and lymph node metastasis (P < .001) were the risk factors for 5-year OS. Multivariate analysis identified tumor invasion depth (P < .001) and lymph node metastasis (P < .001) as independent prognostic factors for the 5-year OS in patients with UTGC. In addition, ROC curve analysis showed that tumor invasion depth (P = .017) or lymph node metastasis (P = .001) alone showed significantly effective prognosis for the 5-year OS in patients with UTGC. For UTGC patients with lymph node metastasis, tumor size (P = .023), lym embolism (P = .003), tumor invasion depth (P = .002), and invasion of tunica serosa (P = .004) were the risk factors for the 5-year OS. Multivariate analysis identified tumor size (P = .048), lym embolism (P = .032), tumor invasion depth (P = .004), and invasion of tunica serosa (P = .031) as independent prognostic factors for the 5-year OS. For UTGC patients with distant metastasis or tumor recurrence, univariate and multivariate analyses demonstrated that tumor invasion depth and lymph node metastasis were independent prognostic factors for the 5-year OS.The results suggested that for UPGC patients undergoing the radical surgical treatment, tumor invasion depth and/or lymph node metastasis are the independent prognostic factors for the 5-year OS, lymph node metastasis, distant metastasis and tumor recurrence.
上三分之一胃癌（UTGC）的发病率一直在上升。然而，根治性手术治疗后UTGC的预后因素仍 largely未知。本研究旨在探讨UTGC患者总生存（OS）、淋巴结转移及复发的预后因素。对126例行根治性手术治疗的UTGC患者的临床病理资料进行回顾性分析。采用Kaplan-Meier分析确定OS及单因素分析，并通过对数秩检验计算曲线间差异的显著性。应用Cox比例风险回归模型进行多因素分析。采用受试者工作特征（ROC）曲线分析确定预后准确性。UTGC患者的1年、3年和5年OS分别为81%、47.6%和38.6%。单因素分析显示，肿瘤大小（P = 0.019）、肿瘤浸润深度（P < 0.001）和淋巴结转移（P < 0.001）是5年OS的危险因素。多因素分析确定肿瘤浸润深度（P < 0.001）和淋巴结转移（P < 0.001）是UTGC患者5年OS的独立预后因素。此外，ROC曲线分析显示，单独的肿瘤浸润深度（P = 0.017）或淋巴结转移（P = 0.001）对UTGC患者的5年OS具有显著有效的预后价值。对于有淋巴结转移的UTGC患者，肿瘤大小（P = 0.023）、淋巴管栓塞（P = 0.003）、肿瘤浸润深度（P = 0.002）和浆膜侵犯（P = 0.004）是5年OS的危险因素。多因素分析确定肿瘤大小（P = 0.048）、淋巴管栓塞（P = 0.032）、肿瘤浸润深度（P = 0.004）和浆膜侵犯（P = 0.031）是5年OS的独立预后因素。对于有远处转移或肿瘤复发的UTGC患者，单因素和多因素分析均表明肿瘤浸润深度和淋巴结转移是5年OS的独立预后因素。结果表明，对于接受根治性手术治疗的UPGC患者，肿瘤浸润深度和/或淋巴结转移是5年OS、淋巴结转移、远处转移及肿瘤复发的独立预后因素。
