作者：王新友，张冯祥，郭建平，王华摄，练磊

单位：中山大学附属第六医院 胃外科, 广东 广州 510655

Authors: Wang Xinyou, Zhang Fengxiang, Guo Jianping, Wang Huashe, Lian Lei

Unit: Department of Gastric Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong, China

摘要：

目的 探究胃印戒细胞癌(signet ring cell carcinoma, SRC)与非印戒细胞型胃腺癌(non-signet ring cell adenocarcinoma, NSRC)的临床病理学特征及预后是否存在差异。方法 回顾性收集2008年1月至2019年12月在中山大学附属第六医院行根治性胃大部分切除术或全胃切除术治疗的胃癌患者资料,分析胃SRC组与NSRC组的各项临床病理资料的差异,并对两组的总生存率进行比较。然后采取倾向性评分匹配法对协变量进行匹配,比较匹配后胃SRC组与NSRC组的总生存率差异,并通过Cox比例风险回归模型分析影响胃癌患者预后的因素。结果 共1050例患者纳入分析,其中胃SRC组122例,NSRC组928例。两组在年龄、性别、肿瘤部位、手术方式、T分期、N分期、肿瘤TNM分期、CEA、腹膜转移等方面比较差异有统计学意义(P<0.05),两组的总生存率差异无统计学意义。对所有协变量进行匹配后,SRC组115例,NSRC组291例,两组的Ⅰ期患者的总生存率差异无统计学意义(P>0.05),对于Ⅱ～Ⅳ期的患者,胃SRC的总生存率比NSRC患者差,差异有统计学意义(P<0.05)。Cox多因素分析结果表明: SRC(HR=1.76, 95%CI: 1.04～2.99, P=0.04)、年龄≥60岁(HR=2.18, 95%CI:  1.22～3.91, P=0.008)、较高的T分期(T3, HR=9.34, 95%CI: 2.32～37.59 ,P=0.002; T4, HR=13.40, 95%CI: 3.00～59.77 ,P=0.001)、较高的N分期(N2, HR=2.98, 95%CI: 1.45～6.12, P=0.003; N3, HR=2.47, 95%CI: 1.09～5.62, P=0.03)是胃癌总生存率不良的独立危险因素,而BMI>18.5 kg/m2是保护性因素。结论 胃SRC是胃癌的一种特殊组织学类型,有着独特的临床病理学特征和预后表现,对于Ⅰ期胃癌患者,胃SRC患者的预后与NSRC患者相当,对于Ⅱ～Ⅳ期SRC患者的预后明则显差于NSRC患者。

关键词： 胃癌; 印戒细胞癌; 预后; 倾向性评分匹配

Abstract：

Objective To explore the differences in clinicopathological features and prognosis between gastric signet ring cell carcinoma （SRC） and non-signet ring cell adenocarcinoma （NSRC）. Methods Patients with gastric adenocarcinoma who accepted subtotal or total gastrectomy between January 2008 and December 2019 in our hospital were retrospectively collected and analyzed. Differences in clinicopathological features and prognosis between SRC and NSRC were compared. Then propensity score matching （PSM） was applied to adjust confounding factors between groups for further analysis, including OS, univariate and multivariate Cox regression analysis. Results A total of 1050 cases were eventually included in the study, including 122 cases of SRC and 928 cases of NSRC. For clinicopathological features, there were significant differences in the distribution of age, sex, tumor site, approach of surgery, T stage, N stage, TNM stage, carcinoembryonic antigen, peritoneal metastases （P＜0.05）. There was no difference in OS between SRC and NSRC. After PSM adjusted for confounding factors, 115 cases of SRC and 291 cases of NSRC were matched, and for patients with stage Ⅰ, there was no significant difference between two groups in OS （P>0.05）, while SRC had signif icantly worse OS for patients with stage Ⅱ-Ⅳ （P＜0.05）. Multivariate Cox regression analysis showed that SRC （HR=1.76, 95% CI: 1.04-2.99, P=0.04）, over 60 years old （HR=2.18, 95% CI:1.22-3.91, P=0.008）, advanced T stage （T3, HR=9.34, 95% CI: 2.32-37.59, P=0.002; T4, HR=13.40, 95% CI: 3.00-59.77, P＝0.001）, advanced N stage （N2, HR=2.98, 95% CI: 1.45-6.12, P=0.003; N3, HR=2.47, 95% CI: 1.09-5.62, P＝0.03） were independent risk factors for poor OS of patients with gastric cancer, while BMI ＞18.5 kg/m2 was protective factor. Conclusions SRC is a special histopathological subtype of gastric cancers with distinctive clinicopathological features and prognosis. For patients with stage Ⅰ, SRC has comparable prognosis with NSRC, while prognosis of SRC at stage Ⅱ-Ⅳ is significantly poorer.

Key Words: Gastric cancer; Signet ring cell carcinoma; Prognosis; Propensity score matching