作者：周薇薇1，雷海科2，李小升3，赵玉兰4，戴羽5，周宏6

单位：1.重庆大学附属肿瘤医院 科研外事部，重庆 400030；2.重庆大学附属肿瘤医院 预约随访中心，重庆 400030；3.重庆大学附属肿瘤医院 病案统计室，重庆 400030；4.重庆大学附属肿瘤医院 医保管理部，重庆 400030；5.重庆大学附属肿瘤医院 教务科，重庆 400030；6.重庆大学附属肿瘤医院 院长办公室，重庆 400030

Authors:  Zhou Weiwei1, Lei Haike2, Li Xiaosheng3, Zhao Yulan4, Dai Yu5, Zhou Hong6

Unit:  1.Scientific Research and Foreign Affairs Department, Chongqing University Cancer Hospital, Chongqing 400030, China；2.Department of Appointment and Follow-up Center, Chongqing University Cancer Hospital, Chongqing 400030, China；3.Medical Records and Statistics Room, Chongqing University Cancer Hospital, Chongqing 400030, China；4.Department of Medical Insurance Management, Chongqing University Cancer Hospital, Chongqing 400030, China；5.Educational Administration Department, Chongqing University Cancer Hospital, Chongqing 400030,China；6.Deanery, Chongqing University Cancer Hospital, Chongqing 400030, China

摘要：

目的 分析重庆市有特殊病种医保的胃癌患者生存情况,为胃癌患者的生存预后评价及防治提供参考依据。方法 对重庆市恶性肿瘤特殊病种办理系统中2000年1月至2018年12月确诊的2187例胃癌患者进行回顾性队列研究,随访时间截至2018年12月31日。采用Kaplan-Meier法计算生存率,采用对数秩检验(Log-rank test)、Cox比例风险回归模型分别进行影响胃癌患者预后的单因素和多因素分析,采用GraphPad Prism8.0绘制生存曲线。结果 胃癌患者的中位生存时间为57.03个月(95%CI:49.10～64.96),1、3、5年观察生存率分别为78.10%、60.72%、48.68%。≥75岁年龄组患者生存率低于其他年龄组,TNMⅠ～Ⅱ期患者生存率高于Ⅲ期、Ⅳ期患者,肿瘤侵犯肌层及以上组织的患者生存率高于侵犯肌层以下组织者,无淋巴结转移、无远处转移患者生存率高于有淋巴结转移、有远处转移者,高分化患者生存率高于中低分化患者,手术治疗患者生存率高于未手术者,差异均具有统计学意义(P<0.05);不同性别患者生存率差异无统计学意义(P>0.05)。Cox回归分析结果表明,年龄、TNM临床分期、浸润深度(T)、阳性淋巴结(N)是影响胃癌患者生存预后的独立危险因素。结论 年龄、TNM临床分期、浸润深度(T)、阳性淋巴结(N)可独立影响胃癌患者的生存预后,采取三级综合防治措施,有利于改善区域胃癌患者的生存预后。

关键词：胃癌; 特殊病种; 生存随访; 观察生存率; 预后

Abstract：

Objective To analyze the survival of patients with gastric cancer who have special medical insurance in Chongqing, and provide reference for prognosis evaluation and prevention of gastric cancer. Methods The retrospective cohort study was conducted to enroll 2187 gastric cancer patients who were diagnosed and treated from January 2010 to December 2018 in the Chongqing Malignant Tumor Treatment System, and the follow-up time was up to December 31, 2018.The survival rate was calculated by Kaplan-Meier method, the Log-rank test and Cox proportional risk regression models were used to analyze the univariate and multivariate factors affecting the prognosis of gastric cancer patients, and the survival curve was plotted by GraphPad Prism8.0. Results The median survival time was 57.03 months (95%CI: 49.10-64.96) , and the 1-, 3-, and 5-year observed survival rates were 78.10%, 60.72%, 48.68%, respectively. The survival rate of 75 years or older patients was lower than that of other age groups. TNM stage Ⅰ-Ⅱ patients had higher survival rate than that of patients with stage Ⅲand Ⅳ. Survival rates were higher in patients whose tumors invaded tissues at or above the muscular layer than in those who invaded tissues below the muscular layer. The survival rates of patients without lymph node metastasis or distant metastasis, with high differentiation and surgical treatment were higher than that of patients with lymph node metastasis or distant metastasis, middle or low differentiation and no surgical treatment. All the above differences were statistically significant (P<0.05) . But there was no significant difference in survival rate between different genders (P>0.05). Cox regression analysis showed that age, TNM clinical stage, infiltration depth (T) and positive lymph node (N) were independent risk factors for survival and prognosis of gastric cancer patients. Conclusions Age, TNM clinical stage, infiltration depth (T) and positive lymph node (N) can independently affect the survival and prognosis of gastric cancer patients. Three-level comprehensive prevention and treatment measures could help improve the survival and prognosis of gastric cancer patients in the region.

Key Words:  Gastric cancer; Special medical; Survival follow-up; Observed survival rate; Prognosis