作者：黄嘉华，唐维，李广华，何裕隆 ，王志雄

单位：中山大学附属第一医院 胃肠外科中心，广东 广州 510080

Authors: Huang Jiahua, Tang Wei, Li Guanghua, He Yulong, Wang Zhixiong

Unit: Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat -sen University, Guangzhou 510080, Guangdong, China

摘要：

目的 探索肿瘤出芽(TB)对术前癌胚抗原(CEA)正常的Ⅰ～Ⅲ期结直肠癌患者预后价值。方法 回顾性收集解放军总医院海南医院经手术完整切除后病理确诊且术前CEA在正常范围内的Ⅰ～Ⅲ期结直肠癌病例87例,通过苏木精-伊红染色判读TB后将患者分为TB低组和TB高组,分析两组患者不同临床病理参数的不同及无病生存(DFS)期、总生存(OS)期的差异。结果TB高组患者更多表现为存在淋巴结转移(N1+2)、Ⅲ期(均P <0.01);TB低组患者不论是DFS (Log rank=4.48,P=0.03)还是OS (Log rank=5.74,P=0.02)均优于TB高组;单因素分析显示TB是DFS和OS的预测因子,但多因素分析仅显示TB是OS的独立预测因子(HR=3.25,95%CI:1.07～9.83,P=0.04)。结论 在CEA正常的Ⅰ～Ⅲ期结直肠癌患者中,TB对患者预后判断具有重要价值,TB较低的患者预后优于较高的患者。

关键词：Borrmann Ⅳ型胃癌；临床病理特点；倾向评分匹配；生存分析；预后因素

Abstract：

Objective Analyze the clinicopathological features and prognosis of Borrmann type Ⅳ gastric cancer with non -Borrmann type Ⅳ gastric cancer. Method The clinicopathological information of 2525 patients with advanced gastric cancer treated in the Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University from August 1994 to August 2021 were analyzed retrospectively. The clinicopathological features of Borrmann type Ⅳ gastric cancer and non-Borrmann type Ⅳ gastric cancer were compared. The matching cohort was obtained by propensity score matching（PSM）, and the prognosis differences between the two groups were compared. Univariate and multivariate Cox proportional hazard models were used to analyze the factors of patients with Borrmann type Ⅳ gastric cancer. Result Among the 2525 cases of gastric cancer, there were 287 cases of Borrmann type Ⅳ gastric cancer and 2238 cases of non[1]Borrmann type Ⅳ gastric cancer. There were significant differences between the two groups in diagnosis age, gender, tumor location, tumor size, histological type, depth of invasion, lymph node metastasis, peritoneal dissemination TNM stage, and R0 resection（P<0.05）. There was no significant difference in liver metastasis, human epidermal receptor 2（HER-2）, microsatellite status and postoperative adjuvant chemotherapy（P>0.05）; Kaplan-Meier survival analysis showed that the 5-year survival rate of Borrmann type Ⅳ gastric cancer was 17.3%. Kaplan -Meier survival analysis before and after matching showed that the prognosis of this type of gastric cancer was worse than that of other Borrmann types of gastric cancer. Multivariate Cox proportional hazard model analysis showed that tumor invasion of the serosa or adjacent structures（pT4）（HR=1.56, 95%CI: 1.09-2.23, P=0.015 and pTNM stage Ⅳ（HR=2.00, 95%CI: 1.44-2.77, P<0.001）were independent risk factors for prognosis, and R0 surgical resection（HR=0.43, 95%CI: 0.28-0.67, P<0.001）was independent protective factor. Conclusion Borrmann type Ⅳ gastric cancer has the characteristics of strong invasive capacity, high metastasis rate and low radical resection rate. The prognosis of this type of gastric cancer is poor. Early diagnosis and radical surgery can improve the prognosis of this type of gastric cancer.

Key Words: Borrmann type Ⅳ gastric cancer; Clinicopathological features; Propensity score matching; Survival analysis; Prognostic factors