国际肿瘤学杂志

国际肿瘤学杂志 ›› 2025, Vol. 52 ›› Issue (12): 764-769.doi: 10.3760/cma.j.cn371439-20250509-00130

• 论著 • 上一篇    下一篇

胃癌术后腹膜转移患者预后的影响因素分析

刘萍萍, 王俊毅, 林志伟, 陈大朝()   

  1. 第九〇九医院（厦门大学附属东南医院）肿瘤科，漳州 363000
  • 收稿日期:2025-05-09 修回日期:2025-06-03 出版日期:2025-12-08 发布日期:2025-12-31
  • 通讯作者: 陈大朝 E-mail:chendachaocdc@qq.com

Analysis of factors influencing the prognosis of patients with postoperative peritoneal metastasis of gastric cancer

Liu Pingping, Wang Junyi, Lin Zhiwei, Chen Dachao()   

  1. Department of Oncology，909th Hospital （Dongnan Hospital of Xiamen University），Zhangzhou 363000，China
  • Received:2025-05-09 Revised:2025-06-03 Online:2025-12-08 Published:2025-12-31
  • Contact: Chen Dachao E-mail:chendachaocdc@qq.com

RichHTML

1

PDF

1

摘要：

目的 探讨胃癌术后腹膜转移患者预后的影响因素。方法 回顾性分析第九〇九医院（厦门大学附属东南医院）2022年1月至2023年12月收治的141例胃癌术后腹膜转移患者的临床资料。所有患者随访1年，分析不同结局患者临床特征，采用Cox比例风险回归模型分析患者预后的影响因素，绘制Kaplan-Meier生存曲线图，采用log-rank检验比较不同影响因素患者1年总生存（OS）率。结果 141例胃癌术后腹膜转移患者51例死亡，患者1年OS率为70.20%，中位OS为13个月。死亡患者与存活患者淋巴结转移（χ2=9.17，P=0.002）、脉管侵犯（χ2=11.78，P=0.001）、癌结节（χ2=10.04，P=0.002）、Borrmann分型（χ2=6.81，P=0.009）、TNM分期（χ2=22.22，P<0.001）、系统性治疗（χ2=6.47，P=0.011）、腹腔灌注化疗（χ2=10.28，P=0.001）差异均有统计学意义。多因素分析显示，淋巴结转移（HR=2.15，95%CI为1.44~6.53，P=0.010）、脉管侵犯（HR=1.98，95%CI为1.28~6.91，P=0.023）、癌结节（HR=1.98，95%CI为1.26~7.98，P=0.042）、TNM分期（HR=2.09，95%CI为1.37~8.03，P=0.025）、腹腔灌注化疗（HR=2.19，95%CI为1.53~6.30，P=0.008）均是胃癌术后腹膜转移患者预后影响因素。生存曲线分析显示，有淋巴结转移、无淋巴结转移患者的1年OS率分别为50.0%、74.7%，差异有统计学意义（χ2=9.77，P=0.002）；有脉管侵犯、无脉管侵犯患者的1年OS率分别为47.5%、75.6%，差异有统计学意义（χ2=12.51，P<0.001）；有癌结节、无癌结节患者的1年OS率分别为34.8%、69.5%，差异有统计学意义（χ2=11.80，P=0.001）；TNM分期Ⅰ、Ⅱ期患者的1年OS率分别为80.2%、41.7%，差异有统计学意义（χ2=20.64，P<0.001）；无腹腔灌注化疗、有腹腔灌注化疗患者的1年OS率分别为52.5%、78.7%，差异有统计学意义（χ2=9.83，P=0.002）。结论 淋巴结转移、脉管侵犯、癌结节、TNM分期Ⅱ期、无腹腔灌注化疗均是胃癌术后腹膜转移患者预后的危险因素。

关键词: 胃肿瘤, 肿瘤转移, 腹膜, 预后

Abstract:

Objective To investigate the factors influencing the prognosis of patients with postoperative peritoneal metastasis of gastric cancer. Methods The clinical data of 141 patients with postoperative peritoneal metastasis of gastric cancer admitted to the 909th Hospital （Dongnan Hospital of Xiamen University） from January 2022 to December 2023 were analyzed retrospectively. All patients were followed up for 1 year， and the clinical characteristics of patients with different outcomes were analyzed. The Cox proportional hazards regression model was used to analyze factors influencing patients' prognosis， Kaplan-Meier survival curves were plotted， and the log-rank test was employed to compare 1-year overall survival （OS） rates among patients with different influencing factors. Results Among 141 patients with peritoneal metastasis after gastric cancer surgery， 51 died. The 1-year OS rate of the patients was 70.20%， and the median OS was 13 months. There were statistically significant differences in terms of lymph node metastasis （χ2=9.17， P=0.002）， vascular invasion （χ2=11.78， P=0.001）， cancer nodules （χ2=10.04， P=0.002）， Borrmann type （χ2=6.81， P=0.009）， TNM stage （χ2=22.22， P<0.001）， systemic treatment （χ2=6.47， P=0.011）， and intraperitoneal perfusion chemotherapy （χ2=10.28， P=0.001） between deceased and surviving patients. Multivariate analysis showed that， lymph node metastasis （HR=2.15， 95%CI： 1.44-6.53， P=0.010）， vascular invasion （HR=1.98， 95%CI： 1.28-6.91， P=0.023）， cancer nodules （HR=1.98， 95%CI： 1.26-7.98， P=0.042）， TNM stage （HR=2.09， 95%CI： 1.37-8.03， P=0.025）， and intraperitoneal perfusion chemotherapy （HR=2.19， 95%CI： 1.53-6.30， P=0.008） were all factors influencing the prognosis of patients with postoperative peritoneal metastasis of gastric cancer. Survival curve analysis showed that， the 1-year OS rates of patients with and without lymph node metastasis were 50.0% and 74.7%， respectively， with a statistically significant difference （χ2=9.77， P=0.002）； the 1-year OS rates of patients with and without vascular invasion were 47.5% and 75.6%， respectively， with a statistically significant difference （χ2=12.51， P<0.001）； the 1-year OS rates of patients with and without cancer nodules were 34.8% and 69.5%， respectively， with a statistically significant difference （χ2=11.80， P=0.001）； the 1-year OS rates of patients with TNM stage Ⅰ and Ⅱ were 80.2% and 41.7%， respectively， with a statistically significant difference （χ2=20.64， P<0.001）； and the 1-year OS rates of patients without and with intraperitoneal perfusion chemotherapy were 52.5% and 78.7%， respectively， with a statistically significant difference （χ2=9.83， P=0.002）. Conclusions Lymph node metastasis， vascular invasion， cancer nodules， TNM stage Ⅱ， and no intraperitoneal perfusion chemotherapy are all risk factors for the prognosis of patients with postoperative peritoneal metastasis of gastric cancer.

Key words: Stomach neoplasms, Neoplasm metastasis, Peritoneum, Prognosis