Xu Ran, Zhang Yisheng, Zhao Jun, Chen Ke, Wang Zhengguang
Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of General Surgery, The Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.
Department of General Surgery, The Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.
Eur J Surg Oncol. 2023 Apr;49(4):845-852. doi: 10.1016/j.ejso.2022.12.004. Epub 2022 Dec 14.
The purpose of this study was to assess the prognostic value of TD in lymph node-negative GC.
A retrospective study was conducted to collect the clinicopathological data from 1224 patients with lymph node-negative GC. According to their TD status, patients were categorized into TD-positive and TD-negative groups. Patients in both groups underwent a 1:1 propensity score matching analysis. Survival analysis was performed by the Kaplan-Meier method, and the differences between survival curves were measured by log-rank test. The cox proportional hazards model was used for univariate and multivariate analyses.
The TD-negative group had higher 5-year overall survival(OS) rate than TD-positive group(69.4%VS.36.4%,P < 0.05). Further subgroup analysis indicated that patients in the TD-negative group had higher 5-year OS rates than those in the TD-positive group in the T1-2, T3, and T4 subgroups(all with P < 0.05).The OS rates were decreased with the increase of the number of TD.The univariate Cox regression analysis demonstrated that tumor location in antrum, distal gastrectomy, perineural invasion, T4-stage,lymphovascular invasion and the number of TD were all associated with prognosis in patients undergoing curative gastric resection (P < 0.05).The multivariable analysis revealed that the number of TD, perineural invasion, lymphovascular invasion and T4 stage were independently associated with OS.
In lymph node-negative GC, TD is an independent risk factor for prognosis, regardless of T-stage, and patients with ≥3 TD have a worse prognosis.
本研究旨在评估肿瘤芽生(TD)在淋巴结阴性胃癌(GC)中的预后价值。
进行一项回顾性研究,收集1224例淋巴结阴性GC患者的临床病理数据。根据TD状态,将患者分为TD阳性组和TD阴性组。两组患者进行1:1倾向评分匹配分析。采用Kaplan-Meier法进行生存分析,通过对数秩检验测量生存曲线之间的差异。使用Cox比例风险模型进行单因素和多因素分析。
TD阴性组的5年总生存率(OS)高于TD阳性组(69.4%对36.4%,P<0.05)。进一步亚组分析表明,在T1-2、T3和T4亚组中,TD阴性组患者的5年OS率高于TD阳性组患者(均P<0.05)。OS率随着TD数量的增加而降低。单因素Cox回归分析表明,胃窦部肿瘤位置、远端胃切除术、神经周围侵犯、T4期、淋巴管侵犯和TD数量均与接受根治性胃切除术患者的预后相关(P<0.05)。多因素分析显示,TD数量、神经周围侵犯、淋巴管侵犯和T4期与OS独立相关。
在淋巴结阴性GC中,无论T分期如何,TD都是预后的独立危险因素,TD≥3的患者预后较差。