Risk Factors of Vascular Invasion in Patients with Resectable Gastric Cancer
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摘要:目的
分析可切除胃癌患者的临床病理特征，探讨其发生脉管转移的相关危险因素及对患者预后的影响。
方法回顾性分析接受手术切除的1 077例Ⅰ~Ⅲ期胃癌患者资料，根据是否发生脉管转移分为LVI阳性组（672例）与LVI阴性组（405例）。Logistic单因素和多因素分析患者临床病理特征与LVI的关系。利用生存分析研究Ⅰ期胃癌患者脉管侵犯与生存率之间的关系。
结果单因素分析结果显示，肿瘤大小、分化类型、浸润深度、淋巴结转移、TNM分期、Lauren分型、神经侵犯以及CEA、CA125、CA199的升高是发生脉管侵犯的危险因素（P < 0.05）。多因素分析结果显示，肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高是发生脉管侵犯的独立风险因素。有脉管侵犯的Ⅰ期胃癌患者5年生存率明显低于无脉管侵犯的患者，两者差异有统计学意义（P < 0.01）。
结论肿瘤分化不良、浸润程度深、有淋巴结转移、侵犯神经、CA724升高的胃癌患者更容易发生脉管侵犯。对于有可能发生脉管侵犯的Ⅰ期胃癌患者，应采取更积极的治疗手段。
Abstract:ObjectiveTo explore the risk factors for vascular invasion and its influence on prognosis of resectable gastric cancer patients by analyzing the clinicopathological features.
MethodsWe retrospectively analyzed the data of 1077 patients with stage Ⅰ-Ⅲ gastric cancer who underwent surgical resection. According to whether vascular invasion occurred, they were divided into LVI positive group (n=672) and LVI negative group (n=405). Logistic univariate and multivariate analyses were used for the relation between clinical pathological features and LVI. Survival analysis was used to study the relation between vascular invasion and survival rate in patients with stage Ⅰ gastric cancer.
ResultsUnivariate analysis showed that tumor size, type of differentiation, depth of invasion, lymph node metastasis, TNM stage, Lauren classification, nerve invasion and the increase of CEA, CA125 and CA199 were risk factors for vascular invasion (P < 0.05). Multivariate analysis showed that poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 were independent risk factors for vascular invasion. The 5-year survival rate of stage Ⅰ gastric cancer patients with vascular invasion was significantly lower than that without vascular invasion (P < 0.01).
ConclusionGastric cancer patients with poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 are more prone to vascular invasion. Patients with stage I gastric cancer at risk of vascular invasion should be treated more aggressively.
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Key words:
- Gastric cancer /
- Stage Ⅰ gastric cancer /
- Vascular invasion /
- Risk factors /
- Prognosis
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Competing interests: The authors declare that they have no competing interests.作者贡献：乔一桓：实验设计、实施，采集分析数据，撰写文章李纪鹏：实验设计、对文章的知识性内容作批评性审阅及指导陈乐、杜正华、郭源：采集及分析数据；支持性贡献
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图 1 有无脉管侵犯的Ⅰ期胃癌患者Kaplan-Meier生存曲线
Figure 1 Kaplan-Meier survival curves of stage Ⅰ gastric cancer patients with and without vascular invasion
表 1 胃癌患者脉管侵犯危险因素的单因素分析结果
Table 1 Univariate analysis of risk factors for vascular invasion in patients with gastric cancer
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表 2 Ⅰ~Ⅲ胃癌患者脉管侵犯危险因素的多因素分析结果
Table 2 Multivariate analysis of risk factors for vascular invasion in patients with stage Ⅰ-Ⅲ gastric cancer
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