行根治术的Ⅲ期胃癌患者预后影响因素分析

doi:10.3969/j.issn.1004-616x.2023.01.006

摘要/Abstract

摘要： 目的: 探讨行根治术的Ⅲ期胃癌患者预后影响因素。方法: 选择于2017年1月—2021年4月进行手术治疗的116例Ⅲ期胃癌患者为研究对象，收集患者一般资料和临床指标。比较患者术前血清C反应蛋白(CRP)、细胞程序性死亡-配体1(PD-L1)、促血管生成素-2(Ang-2)浓度与临床病理指标的相关性，采用受试者工作特征(ROC)曲线确定术前血清指标的最佳截断值，采用Kaplan-Meier法分析患者生存情况，建立Cox比例风险回归模型进行多因素分析，通过列线图模型分析各因素在胃癌预后预测中的价值。结果: 胃癌患者术前CRP、PD-L1、Ang-2浓度在不同年龄、肿瘤直径、脉管侵犯、神经侵犯、浸润深度、淋巴结转移、淋巴结转移度、分化程度组患者间的差异均具有统计学意义(P<0.05)。生存分析结果显示，术前血清CRP浓度<19.53 mg/L、PD-L1浓度≥42.80 pg/mL、Ang-2浓度<305.16 μg/L时患者平均生存期较长、1年生存率较高(P<0.05)。Cox比例风险回归分析结果显示，术前CRP、PD-L1、Ang-2浓度、肿瘤直径、脉管侵犯、神经侵犯、浸润深度、淋巴结转移、分化程度为胃癌患者预后的独立预测因子(P<0.05)，列线图预测模型一致性指数为0.863，校准曲线检验表明与实际发生概率具有较高的一致性。结论: 胃癌患者根治术前血清CRP浓度超过19.53 mg/L、术前血清PD-L1浓度低于42.80 pg/mL、术前血清Ang-2浓度超过305.16 μg/L、肿瘤直径超过5 cm、脉管侵犯、神经侵犯、浸润深度超过T3、淋巴结发生转移、低分化的患者具有较差的预后，检测术前血清CRP、PD-L1、Ang-2浓度及肿瘤直径、脉管和神经侵犯度、浸润深度、淋巴结转移、分化程度等病理指标有助于判断患者远期预后。

关键词: 胃癌, C反应蛋白, 细胞程序性死亡-配体1, 促血管生成素-2, 预后

Abstract: OBJECTIVE: To identify prognostic factors among patients with stage Ⅲ gastric cancers who underwent radical resections. METHODS: From January 2017 to April 2021，116 patients with stage Ⅲ gastric cancers who underwent surgery were selected. General data and preoperative clinical indicators were collected from these patients. Correlations between serum C-reactive protein (CRP)，programmed cell death ligand 1 (PD-L1)，angiopoietin-2 (Ang-2) and clinicopathological parameters were compared. The best cut-off value of serum index before operation was determined by receiver operating characteristic (ROC) curve. Survival conditions of the patients was analyzed by Kaplan-Meier method. Cox proportional hazard regression model was established for multi-factor analysis. The value of factors in predicting prognosis of gastric cancers was evaluated using the line chart model. RESULTS: There were significant differences in preoperative CRP，PD-L1 and Ang-2 levels in age，tumor diameter，vascular invasion，nerve invasion，depth of invasion，lymph node metastasis，lymph node metastasis and differentiation. The results of survival analyses showed that the patients with preoperative serum CRPl <19.53 mg/L，PD-L1 ≥42.80 pg/mL and Ang-2 <305.16 μg/L had longer survival times and higher 1-year survival rates. The results of Cox proportional hazard regression analyses showed that preoperative CRP，PD-L1，Ang-2，tumor diameter，vascular invasion，nerve invasion，depth of invasion，lymph node metastasis and degree of differentiation were independent predictors of prognosis in patients with gastric cancers (P<0.05). The C-index consistency index of the line chart prediction model was 0.863. The calibration curve test showed that the results were highly consistent with the actual occurrence probability. CONCLUSION: In patients with gastric cancers，preoperative serum CRP levels exceeded 19.53 mg/L，preoperative serum PD-L1 levels were lower than 42.80 pg/mL，preoperative serum Ang-2 levels exceeded 305.16 μg/L，tumor diameters exceeded 5 cm，vascular invasion，nerve invasion，depths of invasion were more than T3，and those lymph node metastasis and poor differentiation had better prognosis.-Detection of preoperative serum CRP，PD-L1，Ang-2 concentration，tumor diameter，vascular and nerve invasion，depth of invasion，lymph node metastasis，differentiation and other pathological indicators can be helpful for long-term prognosis of patients.

Key words: gastric cancer, C-reactive protein, programmed cell death-ligand 1, angiopoietin-2, prognosis

中图分类号:

R730.5

许浩, 胡碧川, 邹伟, 段雅斌. 行根治术的Ⅲ期胃癌患者预后影响因素分析[J]. 癌变·畸变·突变, 2023, 35(1): 30-36.

XU Hao, HU Bichuan, ZOU Wei, DUAN Yabin. Identification of prognostic factors among patients with stage Ⅲ gastric cancer undergoing radical resection[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(1): 30-36.

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