淋巴结转移比率与Lauren分型对胃癌根治术后预后预测价值的研究
发布时间:2018-04-30 03:17
本文选题:胃癌 + 淋巴结转移比率 ; 参考:《青岛大学》2017年硕士论文
【摘要】:背景与目的:目前胃癌根治术后远期预后仍较差,因此,确定预测胃癌根治术后生存的相关指标是非常重要的,在我们这个回顾性的研究中,我们探究了淋巴结转移比率与Lauren分型对胃癌根治术后生存预测价值的研究,并且进行了淋巴结转移比率及Lauren分型相应的亚组分析,对清扫淋巴结数目多少对预后的影响进行了探究,比较了淋巴结转移比率与淋巴结分期对预后评估的准确性,分析了淋巴结转移比率与Lauren分型之间的关系,并以淋巴结转移比率作为预后指标对Lauren分型各亚组进行了进一步深入探究。方法:回顾性分析了我院261例病理诊断明确的胃癌根治术后患者的临床资料,运用单因素Kaplan—Meier方法和多因素Cox回归方法对纳入标准的患者进行了生存分析,用受试者工作特征曲线(ROC曲线)探究了淋巴结转移比率(r N)分期与淋巴结分期(p N)对胃癌根治术后患者预后预测评估的准确性。应用寿命表法对淋巴结转移比率分期各亚组的1年、3年、5年的生存率进行了分析,应用卡方检验对淋巴结转移比率与Lauren分型之间的关系进行了深入的分析,应用生存曲线和比例风险回归Cox分析深入探究了以淋巴结转移比率为预后指标在Lauren分型各亚组之间的生存预后价值。结果:单因素分析显示有意义的预后因素包括:肿瘤最大直径(P0.001),淋巴结转移比率(P0.001),Lauren分型(P0.001),淋巴结分期(p=0.001),TNM分期(P0.001),多因素分析显示:肿瘤最大直径(P=0.03),淋巴结转移比率(P0.001),Lauren分型(P0.001),均是胃癌根治术后生存独立的预测指标。通过生存率分析还显示淋巴结转移比率分析越高预后越差,而且Lauren分型中弥漫型预后最差,ROC曲线分析确定了淋巴结转移比率分期对胃癌术后预后生存的预测性较淋巴结分期更加准确。卡方检验分析示淋巴结转移比率与Lauren分型之间无相互关联因素,淋巴结转移比率与Lauren分型均是胃癌根治术后独立的预测因素,Lauren分型的亚组分析确定了淋巴结转移比率可以作为独立的预后指标预测Lauren分型中弥漫型的患者生存。结论:淋巴结转移比率与Lauren分型均是胃癌根治术后患者预后生存的独立预测因素,淋巴结转移比率分期越高预后越差,Lauren分型的三型中,弥漫型预后最差,淋巴结转移比率分期对于胃癌根治术后患者预后生存的预测性优于淋巴结分期。淋巴结转移比率可以作为独立的预后因素预测弥漫型胃癌患者的生存预后。
[Abstract]:Background & objective: at present, the long-term prognosis after radical gastrectomy is still poor. Therefore, it is very important to determine the relevant indicators to predict the survival of gastric cancer after radical gastrectomy. We investigated the prognostic value of lymph node metastasis ratio and Lauren classification on survival after radical gastrectomy, and analyzed the lymph node metastasis ratio and the corresponding subgroup analysis of Lauren classification. The influence of the number of dissected lymph nodes on the prognosis was studied. The accuracy of lymph node metastasis ratio and lymph node staging in evaluating prognosis was compared. The relationship between lymph node metastasis ratio and Lauren classification was analyzed. The lymph node metastasis ratio was used as a prognostic index to further explore the subgroups of Lauren classification. Methods: the clinical data of 261 patients with gastric cancer after radical gastrectomy were analyzed retrospectively. The survival of the patients included in the standard was analyzed by univariate Kaplan-Meier and multivariate Cox regression. The accuracy of lymph node metastasis ratio (rN) staging and lymph node staging (P N) in predicting the prognosis of patients with gastric cancer after radical gastrectomy was investigated by using the operating characteristic curve (ROC curve). The 1 year, 3 year and 5 year survival rates of lymph node metastasis were analyzed by life table method. The relationship between lymph node metastasis ratio and Lauren classification was analyzed by chi-square test. Survival curve and proportional risk regression (Cox) analysis were used to explore the prognostic value of lymph node metastasis ratio among subgroups of Lauren classification. Results: univariate analysis showed that significant prognostic factors included: maximum diameter of tumor (P0.001), lymph node metastasis ratio (P0.001 / Lauren classification), lymph node staging (P 0.001) and TNM staging (P 0.001). Multivariate analysis showed that the maximum diameter of the tumor was 0.03%, and the lymph node metastasis ratio. P0.001 Lauren classification was an independent predictor of survival after radical gastrectomy. Survival analysis also showed that the higher the lymph node metastasis ratio, the worse the prognosis. In Lauren classification, the prognosis of diffuse type was the worst. ROC curve analysis confirmed that lymph node metastasis ratio staging was more accurate than lymph node staging in predicting survival of gastric cancer after operation. Chi-square test showed that there was no correlation between lymph node metastasis ratio and Lauren classification. Lymph node metastasis ratio and Lauren classification are independent predictors of gastric cancer after radical operation. The subgroup analysis of Lauren's classification indicates that lymph node metastasis ratio can be used as an independent prognostic index to predict the survival of diffuse type patients in Lauren classification. Conclusion: lymph node metastasis ratio and Lauren classification are independent prognostic factors for survival of patients with gastric cancer after radical resection. Lymph node metastasis staging was superior to lymph node staging in predicting prognosis of patients with gastric cancer after radical resection. Lymph node metastasis ratio can be used as an independent prognostic factor to predict the survival and prognosis of patients with diffuse gastric cancer.
【学位授予单位】:青岛大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R735.2
【参考文献】
相关期刊论文 前1条
1 Felix Berlth;Elfriede Bollschweiler;Uta Drebber;Arnulf H Hoelscher;Stefan Moenig;;Pathohistological classification systems in gastric cancer:Diagnostic relevance and prognostic value[J];World Journal of Gastroenterology;2014年19期
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