• 1.四川大學(xué)華西醫(yī)院普外科（成都610041）;;
  • 2.中山大學(xué)附屬第一醫(yī)院外科（廣州510080）;;
  • 通訊作者： 詹文華;

目的探討胃癌臨床病理特征及治療方法對患者生存率的影響。
方法以1994年4月至2005年8月手術(shù)治療和病理確診且隨訪資料完整的759 例胃癌患者為對象，對其外科治療結(jié)果進(jìn)行回顧性分析，用Kaplan-Meier計算3年和5年生存率，用Log-rank單因素比較和Cox 回歸多因素分析比較，分析影響胃癌患者術(shù)后生存率的因素。隨訪時間為4～131個月，平均（62.3±6.7）個月。
結(jié)果單因素分析表明，患者的年齡、腫瘤部位、腫瘤直徑、Borrmann分型、組織學(xué)類型、TNM分期、腫瘤浸潤深度、淋巴結(jié)轉(zhuǎn)移、肝轉(zhuǎn)移、腹腔種植、術(shù)中輸血、根治范圍及清掃方法均為影響胃癌患者術(shù)后生存的影響因素。經(jīng)Cox回歸多因素分析發(fā)現(xiàn)，腫瘤部位、直徑、浸潤深度、術(shù)中輸血、淋巴結(jié)清掃范圍、淋巴結(jié)轉(zhuǎn)移、清掃方法、肝轉(zhuǎn)移、腹腔種植及TNM分期為影響患者術(shù)后生存的獨(dú)立預(yù)后因素。
結(jié)論影響胃癌患者術(shù)后生存的獨(dú)立因素有腫瘤部位、大小、淋巴結(jié)轉(zhuǎn)移、腫瘤浸潤深度、腹腔種植、肝轉(zhuǎn)移、病理分期，根治手術(shù)范圍、淋巴結(jié)清掃技術(shù)及術(shù)中輸血是影響患者術(shù)后生存率的重要因素。

引用本文： 韓方海,詹文華,張肇達(dá),何裕隆,周祥. 影響胃癌患者術(shù)后生存因素的Cox回歸分析. 中國普外基礎(chǔ)與臨床雜志, 2006, 13(1): 29-33下轉(zhuǎn)37. doi: 復(fù)制

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3. Kranenbarg EK, van de Velde CJ. Gastric cancer in the elderly [Ｊ]. Eur J Surg Oncol， 1998; 24(5)∶384.
4. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial [Ｊ]. Br J Surg， 1997; 84(11)∶1567.
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6. 劉統(tǒng)成， 詹文華. 早期胃癌病理特點(diǎn)的認(rèn)識及手術(shù)治療的新進(jìn)展 [Ｊ]. 中華胃腸外科雜志， 1999； 2（1）∶ 61.
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10. McCulloch P, Nita ME, Kazi H, et al. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach [Ｊ]. Cochrane Database Syst Rev， 2003; (4)∶CD001964.
11. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
12. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: longterm results of the MRC randomized surgical trial. Surgical Cooperative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
13. 太田惠一郎， 大山繁和， 高橋孝， 他. 胃癌手術(shù)の歷史的変遷 [Ｊ]. 消化器外科， 1999； 22（7）∶1175.
14. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomy——Japan Clinical Oncology Group study 9501 [Ｊ]. J Clin Oncol, 2004; 22(14)∶2767.
15. Bunt AM, Hermans J, Boon MC, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western versus Japanesetype surgery in gastric cancer [Ｊ]. J Clin Oncol, 1994; 12(2)∶417.
16. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach. A patient care study by the American College of Surgeons [Ｊ]. Ann Surg, 1993; 218(5)∶58317McCulloch P. Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985 [Ｊ]. Br J Surg, 1994; 81(3)∶417.
17. Bonenkamp JJ, van de Velde CJ, Kampschoer GH, et al. Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients [Ｊ]. World J Surg, 1993; 17(3)∶410.
18. Kaneda M, Horimi T, Ninomiya M, et al. Adverse affect of blood transfusions on survival of patients with gastric cancer [Ｊ]. Transfusion, 1987; 27(5)∶375.
19. Eroglu A, Canpinar H, Kansu E. Influence of perioperative whole blood transfusions on lymphocyte subpopulations in patients with stage Ⅱ breast cancer [Ｊ]. Med Oncol, 1999; 16(1)∶53.
20. Blumberg N, Heal J, Chuang C, et al. Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence [Ｊ]. Ann Surg, 1988; 207(4)∶410.
  1. 1. Hartgrink HH, van de Velde CJ. Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer [Ｊ]. J Surg Oncol， 2005; 90(3)∶153.
  2. 2. 陳峻青. 胃腸外科學(xué) \[A\] .見： 王吉甫主編. 胃癌 \[M\]. 第1版. 北京： 人民衛(wèi)生出版社， 2000∶360～397.
  3. 3. Kranenbarg EK, van de Velde CJ. Gastric cancer in the elderly [Ｊ]. Eur J Surg Oncol， 1998; 24(5)∶384.
  4. 4. Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial [Ｊ]. Br J Surg， 1997; 84(11)∶1567.
  5. 5. 詹文華. 胃近、遠(yuǎn)端癌臨床療效差異的評價 [Ｊ]. 中國普通外科雜志， 2002; 11（4）∶ 193.
  6. 6. 劉統(tǒng)成， 詹文華. 早期胃癌病理特點(diǎn)的認(rèn)識及手術(shù)治療的新進(jìn)展 [Ｊ]. 中華胃腸外科雜志， 1999； 2（1）∶ 61.
  7. 7. 何裕隆， 陳創(chuàng)奇， 鄭章清， 等. 胃癌侵犯或累及胰十二指腸區(qū)域的手術(shù)治療選擇 [Ｊ]. 中國實(shí)用外科雜志， 2000; 20（11）∶658.
  8. 8. Furukawa H, Hiratsuka M, Iwanaga T. A rational technique for surgical operation on Borrmann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby’s method [Ｊ]. Br J Surg， 1988; 75(2)∶116.
  9. 9. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [Ｊ]. Eur J Surg Oncol， 2004; 30(3)∶303.
  10. 10. McCulloch P, Nita ME, Kazi H, et al. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach [Ｊ]. Cochrane Database Syst Rev， 2003; (4)∶CD001964.
  11. 11. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial [Ｊ]. J Clin Oncol, 2004; 22(11)∶2069.
  12. 12. Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: longterm results of the MRC randomized surgical trial. Surgical Cooperative Group [Ｊ]. Br J Cancer, 1999; 79(9-10)∶1522.
  13. 13. 太田惠一郎， 大山繁和， 高橋孝， 他. 胃癌手術(shù)の歷史的変遷 [Ｊ]. 消化器外科， 1999； 22（7）∶1175.
  14. 14. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended paraaortic lymphadenectomy——Japan Clinical Oncology Group study 9501 [Ｊ]. J Clin Oncol, 2004; 22(14)∶2767.
  15. 15. Bunt AM, Hermans J, Boon MC, et al. Evaluation of the extent of lymphadenectomy in a randomized trial of Western versus Japanesetype surgery in gastric cancer [Ｊ]. J Clin Oncol, 1994; 12(2)∶417.
  16. 16. Wanebo HJ, Kennedy BJ, Chmiel J, et al. Cancer of the stomach. A patient care study by the American College of Surgeons [Ｊ]. Ann Surg, 1993; 218(5)∶58317McCulloch P. Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985 [Ｊ]. Br J Surg, 1994; 81(3)∶417.
  17. 17. Bonenkamp JJ, van de Velde CJ, Kampschoer GH, et al. Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients [Ｊ]. World J Surg, 1993; 17(3)∶410.
  18. 18. Kaneda M, Horimi T, Ninomiya M, et al. Adverse affect of blood transfusions on survival of patients with gastric cancer [Ｊ]. Transfusion, 1987; 27(5)∶375.
  19. 19. Eroglu A, Canpinar H, Kansu E. Influence of perioperative whole blood transfusions on lymphocyte subpopulations in patients with stage Ⅱ breast cancer [Ｊ]. Med Oncol, 1999; 16(1)∶53.
  20. 20. Blumberg N, Heal J, Chuang C, et al. Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence [Ｊ]. Ann Surg, 1988; 207(4)∶410.