切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 429 -433. doi: 10.3877/cma.j.issn.1674-3946.2025.04.021.

论著

不同病理类型进展期胃癌患者临床特征及腹腔镜辅助根治术后短期预后的影响因素
林炳涛1, 陈君填2,()   
  1. 1. 515041 广东汕头,汕头大学医学院
    2. 515041 广东汕头,汕头大学医学院第一附属医院
  • 收稿日期:2024-10-29 出版日期:2025-08-26
  • 通信作者: 陈君填

Clinical characteristics of patients with advanced gastric cancer of different pathological types and influencing factors of short-term prognosis after laparoscopic-assisted radical resection

Bingtao Lin1, Juntian Chen2,()   

  1. 1. Medical College of Shantou University,Shantou Guangdong Province 515041, China
    2. The First Affiliated Hospital of Shantou University Medical College,Shantou Guangdong Province 515041, China
  • Received:2024-10-29 Published:2025-08-26
  • Corresponding author: Juntian Chen
引用本文:

林炳涛, 陈君填. 不同病理类型进展期胃癌患者临床特征及腹腔镜辅助根治术后短期预后的影响因素[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 429-433.

Bingtao Lin, Juntian Chen. Clinical characteristics of patients with advanced gastric cancer of different pathological types and influencing factors of short-term prognosis after laparoscopic-assisted radical resection[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 429-433.

目的

探讨不同病理类型进展期胃癌(AGC)患者腹腔镜辅助根治术(LAG)后短期预后的影响因素。

方法

选取2018年2月至2022年2月100例AGC患者作为研究对象,根据不同病理类型分为胃腺癌(n=45例)、胃黏液腺癌(n=30例)及胃印戒细胞癌(n=25例),采用多元COX回归模型分析其预后影响因素,构建Nomogram预测模型,采用校准曲线、受试者工作特征曲线(ROC)评价其诊断效能,采用Kaplan-Meier生存曲线计算生存率。

结果

不同病理类型AGC患者在肿瘤直径、肿瘤位置、侵犯深度、淋巴管癌栓、区域淋巴结转移及pTNM分期方面差异显著(P<0.05) 胃腺癌患者1年生存率在肿瘤直径、区域淋巴结转移、pTNM分期、肿瘤位置、侵犯深度方面差异显著;胃黏液腺癌患者在pTNM分期、区域淋巴结转移方面差异显著;胃印戒细胞癌患者在pTNM分期、区域淋巴结转移、侵犯深度方面差异显著(P均<0.05);多元Cox回归模型分析显示胃腺癌患者LAG后预后的独立危险因素为pTNM分期、肿瘤部位、侵犯深度、肿瘤直径及区域淋巴结转移,胃印戒细胞癌为区域淋巴结转移及肿瘤侵犯深度,胃黏液腺癌为区域淋巴结转移(P均<0.05);构建列线图预测模型,模型AUC为0.881(95% CI: 0.863-0.884),灵敏度为0.827,特异度为0.795,区分度较好;校准曲线提示模型准确度较高。

结论

不同病理类型的AGC患者,其临床病理特征和预后情况存在差异,临床需根据具体情况采取针对性治疗,以提高患者生存质量。

Objective

To explore the influencing factors of the short-term prognosis of patients with advanced gastric cancer (AGC) of different pathological types after laparoscopic-assisted radical resection(LAG).

Methods

A total of 100 patients with AGC from February 2018 to February 2022 were selected as the research subjects. According to different pathological types, they were divided into gastric adenocarcinoma(n=45 cases), gastric mucinous adenocarcinoma (n=30 cases), and gastric signet ring cell carcinoma (n=25 cases). A multivariate Cox regression model was used to analyze the influencing factors of their prognosis, and a Nomogram prediction model was constructed. The calibration curve and the receiver operating characteristic curve (ROC) were used to evaluate its diagnostic efficacy, and the Kaplan-Meier survival curve was used to calculate the survival rate.

Results

There were significant differences in tumor diameter, tumor location,invasion depth, lymphatic vessel cancer embolus, regional lymph node metastasis, and pTNM stage among AGC patients of different pathological types (P<0.05). The 1-year survival rate of patients with gastric adenocarcinoma showed significant differences in tumor diameter, regional lymph node metastasis, pTNM stage, tumor location, and invasion depth. For patients with gastric mucinous adenocarcinoma, there were significant differences in pTNM stage and regional lymph node metastasis. For patients with gastric signet ring cell carcinoma, there were significant differences in pTNM stage, regional lymph node metastasis, and invasion depth (all P<0.05). Multivariate Cox regression model analysis showed that the independent risk factors for the prognosis of patients with gastric adenocarcinoma after LAG were pTNM stage, tumor site, invasion depth,tumor diameter, and regional lymph node metastasis. For gastric signet ring cell carcinoma, they were regional lymph node metastasis and tumor invasion depth, and for gastric mucinous adenocarcinoma, it was regional lymph node metastasis (all P<0.05). A nomogram prediction model was constructed, with an AUC of the model of 0.881 (95% CI: 0.863-0.884), a sensitivity of 0.827, a specificity of 0.795, and a good discriminability.The calibration curve indicated that the model had a high accuracy.

Conclusion

There are differences in the clinicopathological characteristics and prognosis among AGC patients of different pathological types. Clinically,targeted treatment should be carried out according to specific conditions to improve the quality of life of patients.

表1 三组AGC行LAG患者一般资料对比[例(%)]
因素 胃腺癌(n=45例) 胃黏液腺癌(n=30例) 胃印戒细胞癌(n=25例) χ 2 P
男性 29(64. 4) 21(70. 0) 15(60. 0) 0. 611 0. 737
年龄≥65岁 13(28. 9) 15(50. 0) 12(48. 0) 4. 232 0. 121
肿瘤直径 ≥5cm 28(62. 2) 11(36. 7) 17(68. 0) 6. 719 0. 035
淋巴管癌栓 35(77. 8) 19(63. 3) 12(48. 0) 6. 486 0. 039
神经侵犯 31(68. 9) 24(80. 0) 13(52. 0) 4. 943 0. 084
基础疾病 5. 504 0. 239
 冠心病 11(24. 4) 5(16. 7) 5(20. 0)
 糖尿病 14(31. 1) 7(23. 3) 12(48. 0)
 高血压 20(44. 4) 18(60. 0) 8(32. 0)
肿瘤位置 11. 892 0. 018
 上部 23(51. 1) 11(36. 7) 5(20. 0)
 中部 7(15. 6) 6(20. 0) 12(48. 0)
 下部 15(33. 3) 13(43. 3) 8(32. 0)
区域淋巴结转移 12. 840 0. 045
 N 0 12(26. 7) 4(13. 4) 4(16. 0)
 N 1 5(11. 1) 10(33. 3) 9(36. 0)
 N 2 18(40. 0) 6(20. 0) 4(16. 0)
 N 3 10(22. 2) 10(33. 3) 8(32. 0)
侵犯深度 13. 055 0. 042
 T 2 6(11. 1) 6(20. 0) 5(20. 0)
 T 3 5(13. 3) 8(26. 7) 10(40. 0)
 T 4a 20(44. 4) 7(23. 3) 3(13. 0)
 T 4b 14(31. 1) 9(30. 0) 7(17. 0)
分化程度 8. 731 0. 068
 高分化 7(15. 6) 8(26. 7) 8(32. 0)
 中分化 11(24. 4) 9(30. 0) 11(44. 0)
 低分化 27(60. 0) 13(43. 3) 6(24. 0)
pTNM分期 9. 988 0. 041
 Ⅰb 3(6. 7) 4(13. 3) 6(24. 0)
 Ⅱ 8(17. 8) 5(16. 7) 9(36. 0)
 Ⅲ  34(75. 5) 21(70. 0) 10(40. 0)
表2 三组AGC行LAG患者1年生存率情况对比
表3 AGC患者行LAG相关危险因素分析
图1 列线图预测模型构建
图2 AGC行LAG患者预后生存曲线分析
[1]
Li G, Zhang Z, Chen Z, et al. LncRNA DLEU2 is activated by STAT1 and induces gastric cancer development via targeting miR-23b-3p/NOTCH2 axis and Notch signaling pathway[J]. Life Sci, 2021, 277: 119419.
[2]
Jia Q, Ma Z, Wang Y, et al. Integrated single-step terahertz metasensing for simultaneous detection based on exosomal membrane proteins enables pathological typing of gastric cancer [J].Research, 2025, 8: 625.
[3]
Fisher L. Expression of concern: Upregulation of lncRNA SUMO1P3 promotes proliferation, invasion and drug resistance in gastric cancer through interacting with the CNBP protein [J].RSC Adv, 2022, 12(8): 4572.
[4]
陈维,朱玮,吕成余. 腹腔镜全胃切除胃癌根治术对进展期胃癌患者围术期指标及预后的影响[J]. 中国医学前沿杂志(电子版),2021, 13(03): 130-133.
[5]
Wang ZK, Lin JX, Zheng CH, et al. ASO Author Reflections:Long-Term Efficacy of Splenic Hilar Lymph Node Dissection for Proximal Gastric Cancer [J]. Ann Surg Oncol, 2021, 28(11):6663-6664.
[6]
李建军,乔泽强,庞召果,等. 腹腔镜下胃癌根治术治疗进展期胃癌患者的临床疗效[J]. 癌症进展, 2021, 19(10): 1035-1038.
[7]
Yang H, Wu Z, Liu X, et al. NFIB promotes the progression of gastric cancer by upregulating circMAP7D1 to stabilize HER2 mRNA [J]. Mol Med Rep, 2021, 23(4): 269.
[8]
韦静涛,季鑫,季加孚. 不断提高中国胃癌外科手术治疗规范化[J/CD]. 中华普外科手术学杂志(电子版),2022, 16(03):237-241.
[9]
Fu DJ, Cui XX, Zhu T, et al. Discovery of novel indole derivatives that inhibit NEDDylation and MAPK pathways against gastric cancer MGC803 cells [J]. Bioorg Chem, 2021, 107: 104634.
[10]
朱智勇,马静,陈宜政. 腹型肥胖对胃癌患者腹腔镜远端胃癌根治术近期疗效的影响分析[J/CD]. 中华普外科手术学杂志(电子版),2022, 16(03): 295-298.
[11]
Wu J, Lu G, Zhou S, et al. MicroRNA-30c-2-3p targets STRIP2 to suppress malignant progression of gastric cancer cells [J]. J Biochem, 2022, 171(4): 451-457.
[12]
赵淑樱,张聃. 腹腔镜胃癌外科治疗进展与发展趋势[J]. 中华普外科手术学杂志(电子版),2024, 18(04): 459-462.
[13]
陈凌影,卢春燕. 胃印戒细胞癌的临床病理特征及CT诊断研究进展[J]. 中国普外基础与临床杂志,2022, 29(03): 376-381.
[14]
磊磊,周申康,毕铁男. 全腔镜与腹腔镜辅助远端胃癌根治术的疗效比较[J]. 中国内镜杂志, 2020, 26(04): 40-44.
[15]
韩涛,夏文彬,吕扬,等. 胃癌不同部位特征和预后的对比分析及临床意义[J]. 中国肿瘤临床,2020, 47(23): 1200-1204.
[16]
Wang J, Wang L, Li S, et al. Risk Factors of Lymph Node Metastasis and Its Prognostic Significance in Early Gastric Cancer: A Multicenter Study [J]. Front Oncol, 2021, 11: 649035.
[17]
Ramos MFKP, Pereira MA, Dias AR, et al. Laparoscopic gastrectomy for early and advanced gastric cancer in a western center: a propensity score-matched analysis[J]. Updates Surg,2021, 73(5): 1867-1877.
[18]
Dong YP, Cai FL, Wu ZZ, et al. Risk of station 12a lymph node metastasis in patients with lower-third gastric cancer [J]. World J Gastrointest Surg, 2021, 13(11): 1390-1404.
[1] 李涛, 朱含放, 李世拥. 腹腔镜下经腹腹膜前右侧腹股沟疝修补术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 366-366.
[2] 李凯, 母德安, 陈淋, 张志远, 张伟. 超微创钳辅助经脐单孔腹腔镜肝右前叶切除[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 367-367.
[3] 王浩瑜, 杨拴元, 任彦顺, 阴志强. 两种改良食管空肠吻合术的腹腔镜全胃切除术中临床对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 425-428.
[4] 唐健雄, 李绍杰. 我国腹腔镜疝外科治疗现状、问题与未来[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 355-358.
[5] 田文, 杨晓冬. 我国腹腔镜疝手术治疗难点与对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 359-361.
[6] 李涛, 朱含放, 李世拥. 我国腹腔镜疝修补术式选择与原则[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 362-365.
[7] 朱永慧, 桑迪, 张翠翠. 改良后腹膜优先原位LPD对壶腹部周围癌区域淋巴结清扫和并发症的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 372-375.
[8] 张光亚, 方荣喜, 吴鹏, 肖虎. 腹腔镜下不同入肝血流阻断肝切除治疗原发性肝癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 376-379.
[9] 宁国龙, 左伟, 侯强强. 两种不同手术方案治疗Meckel憩室肠重复畸形患儿的回顾性研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 380-383.
[10] 赵军抗, 张前进, 庄惠杰. 不同导向解剖入路腹腔镜根治术治疗早期直肠癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 401-404.
[11] 雷世杰, 胡饶, 彭鸿, 马俊伟, 高石亮, 晏科金. 头侧-中央混合入路腹腔镜根治术治疗右半结肠癌的临床分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 417-420.
[12] 张小松, 马俊永, 李锡锋, 施乐华, 沈锋. 腹腔镜鞘内解剖性右半肝切除联合区域淋巴结清扫[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 245-245.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜解剖性完全左半肝切除术治疗肝内胆管细胞癌[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 639-639.
[14] 母德安, 向涵, 苏怀东, 张伟. 张氏超微创器械辅助单孔腹腔镜左三叶肝切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 640-640.
[15] 焦振东, 金上博. 腹腔镜肝癌切除术治疗肝癌破裂出血[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 641-641.
阅读次数
全文


摘要