胃癌根治性胃切除术后的腹膜复发：危险因素及预测评分模型

Peritoneal recurrence in gastric cancer after curative gastrectomy: risk factors and predictive score model.

作者信息

Szor Daniel Jose, Pereira Marina Alessandra, Ramos Marcus Fernando Kodama Pertille, Nigro Bruna de Camargo, Dias Andre Roncon, Ribeiro Ulysses

机构信息

Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

出版信息

J Gastrointest Surg. 2025 Jan;29(1):101850. doi: 10.1016/j.gassur.2024.10.005. Epub 2024 Nov 1.

DOI:10.1016/j.gassur.2024.10.005

PMID:39488458

Abstract

BACKGROUND

Peritoneal recurrence (PR) remains the most common pattern of relapse in gastric cancer (GC), even after curative resection. Given its dismal prognosis, the identification of risk factors for PR is essential for developing new treatment modalities and selecting a more appropriate subgroup of patients. This study aimed to evaluate the risk factors and survival outcomes of patients with GC who had PR and to develop a risk score to predict PR.

METHODS

All patients with GC who underwent curative gastrectomy were included. For analysis, patients were divided into no recurrence (NR), recurrence in other sites (ROS), and PR. Risk factors for PR were analyzed to build a risk score.

RESULTS

Among 622 patients with GC, 460 (74.0%) had NR, 98 (15.7%) had ROS, and 64 (10.3%) had PR. Female patients, linitis on computed tomography, depth of tumor invasion, and diffuse/mixed type were associated with PR. Patients with PR had worse overall survival than those with ROS (22.0 vs 29.8 months, respectively; P = .008). The median survival estimates after recurrence were 5.0 months in the PR group and 9.9 months in the ROS group (P < .001). The scoring system developed with 8 variables had an accuracy of 81% in predicting PR. Accordingly, 385 patients (61.9%) were classified as low risk, and 237 patients (38.1%) were classified as high risk. Among the 64 patients with PR, 53 (82.8%) were correctly classified as high risk (P < .001).

CONCLUSION

Patients with PR had distinct clinicopathologic characteristics and extremely restricted survival compared with patients with recurrence in other sites. The risk-scoring model was able to identify patients at higher risk of PR.

摘要

背景

即使在根治性切除术后，腹膜复发（PR）仍是胃癌（GC）最常见的复发模式。鉴于其预后不佳，识别PR的危险因素对于开发新的治疗方式和选择更合适的患者亚组至关重要。本研究旨在评估发生PR的GC患者的危险因素和生存结局，并建立一个预测PR的风险评分。

方法

纳入所有接受根治性胃切除术的GC患者。为进行分析，将患者分为无复发（NR）、其他部位复发（ROS）和PR。分析PR的危险因素以建立风险评分。

结果

在622例GC患者中，460例（74.0%）无复发，98例（15.7%）为其他部位复发，64例（10.3%）发生PR。女性患者、计算机断层扫描显示皮革胃、肿瘤浸润深度和弥漫/混合型与PR相关。发生PR的患者总生存期比发生ROS的患者更差（分别为22.0个月和29.8个月；P = 0.008）。复发后的中位生存估计在PR组为5.0个月，在ROS组为9.9个月（P < 0.001）。由8个变量建立的评分系统预测PR的准确率为81%。因此，385例患者（61.9%）被分类为低风险，237例患者（38.1%）被分类为高风险。在64例发生PR的患者中，53例（82.8%）被正确分类为高风险（P < 0.001）。