胃癌淋巴结转移对不同T分期特异性生存率影响的临床分析

Clinical Analysis of the Effect of Gastric Cancer Lymph Node Metastasis on the Specific Survival Rate of Different T Stages

摘要: 目的：分析胃癌淋巴结转移对不同T分期特异性生存率的影响。方法：以美国SEER数据库为基础，筛选出2010年至2015年信息完整的1918例胃癌手术患者，分析胃癌的特异性生存率(CSS)。生存分析采用K-M法，利用单变量和多变量Cox比例风险回归评估独立预后的生存风险因素，计算并校正特异性死亡的风险比(HR)结果，95%置信区间(CI)。组间逐对比较采用Bonferroni法。结果：胃癌总体病人中，随T分期增加，CSS逐渐降低，HR逐渐升高。无淋巴结转移时，各组CSS和HR变化趋势与总体病人相同，各组病人CSS均较总体病人升高，其中T3期病人CSS上升明显，接近T2期病人。有淋巴结转移时，各组病人CSS均显著降低，T2期CSS最高，T1期和T2期病人组间HR在校正前(HR = 0.961，95% CI 0.599~1.539，P = 0.867)和校正后(HR = 0.886，95% CI 0.552~1.423，P = 0.616)差异均无统计学意义。结论：胃癌淋巴结转移对各组T分期显著降低生存率。无淋巴结转移时，T3期病人生存率升高，接近T2期病人。有淋巴结转移时，T1期生存率比T2期病人的预后更差。

Abstract: Objective: To analyze the effect of lymph node metastasis on the specific survival rate of different T stages in gastric cancer. Methods: Based on the American SEER database, 1918 patients with gastric cancer with complete information from 2010 to 2015 were selected, and the specific survival rate (CSS) of gastric cancer was analyzed. Survival analysis was conducted using K-M method, univariate and multivariate Cox proportional hazard regression were used to evaluate the survival risk factors of independent prognosis, and the risk ratio of specific death (HR) was calculated and corrected 95% confidence interval (CI). The Bonferroni method was used to compare the groups one by one. Result: In total patients with gastric cancer, CSS decreased and HR increased with the increase of T stage. When there was no lymph node metastasis, the change trend of CSS and HR in each group was same as that in total patients, and the CSS in each group was higher than that in total patients, and the CSS in patients with stage T3 was significantly higher than that in patients with stage T2. When there was lymph node metastasis, the CSS of all patients decreased significantly, and the CSS of stage T2 was the highest. There was no significant difference in HR between stage T1 and stage T2 patients before (HR = 0.961, 95% CI 0.599 - 1.539, P = 0.867) and after adjustment (HR = 0.886, 95% CI 0.552 - 1.423, P = 0.616). Conclusion: Lymph node metastasis of gastric cancer significantly re-duced the survival rate of each T stage group. When there was no lymph node metastasis, the sur-vival rate of patients with stage T3 was higher, which was close to that of patients with stage T2. When there was lymph node metastasis, the survival rate of stage T1 was worse than that of stage T2.