局部进展期胃癌患者根治性切除术后的预后因素分析及模型构建

Prognostic factor analysis and model construction after curative resection in patients with locally advanced gastric cancer

摘要:

目的 分析行根治性切除术的局部进展期胃癌（LAGC）患者预后因素并构建预后模型。方法 回顾性分析2015年1月—2018年12月于苏州大学附属张家港医院行胃癌根治性切除术的186例LAGC患者的临床病理资料。随访5年，根据随访情况将研究对象分为生存组（112例）和死亡组（74例）。采用多因素Cox回归分析筛选影响LAGC患者预后的影响因素并构建列线图模型。结果 生存组年龄、肿瘤直径小于死亡组，低/中低肿瘤分化程度占比低于死亡组，临床肿瘤Ⅱ期占比高于死亡组，中性粒细胞与淋巴细胞比值（NLR）低于死亡组（P <0.05）。多因素一般Cox回归分析发现，年龄大［H^R=1.054（95% CI：1.014，1.096）］、肿瘤直径大［H^R=1.416（95% CI：1.117，1.794）］、临床分期Ⅲ期［H^R=3.474（95% CI：1.671，7.221）］和NLR高［H^R=2.598（95% CI：1.529，4.414）］是LAGC患者根治性切除术后的危险因素（P <0.05），肿瘤分化程度高或中高［H^R=0.339（95% CI：0.163，0.705）］是LAGC患者根治性切除术后的保护因素（P <0.05）。ROC曲线分析结果显示，联合检测的曲线下面积为0.821，敏感性为70.3%（95% CI：0.585，0.803），特异性为86.6%（95% CI：0.789，0.923）。高年龄组生存率低于低年龄组（P <0.05），肿瘤直径较大组生存率低于肿瘤直径较小组（P <0.05），低/中分化程度组生存率高于高/中分化程度组（P <0.05），临床分期Ⅱ期组生存率高于临床分期Ⅲ期组（P <0.05），高NLR组生存率低于低NLR组（P <0.05）。结论 年龄、肿瘤直径、肿瘤分化程度、临床分期和NLR是LAGC患者预后的影响因素，且年龄、肿瘤直径、肿瘤分化程度、临床分期和NLR联合检测对LAGC患者预后价值较高。

Abstract:

Objective To analyze prognostic factors and construct a prognostic model for patients with locally advanced gastric cancer (LAGC) who underwent curative resection.Methods A retrospective analysis was conducted on the clinicopathological data of 186 LAGC patients who underwent curative resection at Affiliated Zhangjiagang Hospital of Soochow University between January 2015 and December 2018. Patients in the training cohort were followed up for 5 years and were subsequently classified into a survival group (n = 112) and a death group (n = 74) according to follow-up outcomes. Multivariable Cox proportional hazards regression analysis was performed to identify prognostic factors for LAGC, and a nomogram model was constructed based on the identified variables.Results Compared with the death group, patients in the survival group were younger, had smaller tumor diameters, a lower proportion of low/poor tumor differentiation, a higher proportion of clinical stage II disease, and lower neutrophil-to-lymphocyte ratios (NLR) (all P < 0.05). Multivariable Cox proportional hazards regression analysis identified older age [H^R = 1.054 (95% CI: 1.014, 1.096) ], larger tumor diameter [H^R = 1.416 (95% CI: 1.117, 1.794) ], clinical stage III disease [H^R = 3.474 (95% CI: 1.671, 7.221) ], and elevated NLR higher[H^R = 2.598 (95% CI: 1.529, 4.414) ] as independent risk factors for prognosis after curative resection in patients with LAGC (all P < 0.05). In contrast, well or moderately differentiated tumors [H^R = 0.339 (95% CI: 0.163, 0.705) ] were identified as a protective factor (P < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the combined detection achieved an area under the curve (AUC) of 0.821, with a sensitivity of 70.3% (95% CI: 0.585, 0.803) and a specificity of 86.6% (95% CI: 0.789, 0.923). Patients in the older age group had lower survival rates than those in the younger age group (P < 0.05). Similarly, patients with larger tumor diameters exhibited lower survival rates compared with those with smaller tumors (P < 0.05). Patients with lowly or moderately differentiated tumors showed higher survival rates than those with high or moderately high differentiation (P < 0.05). Survival was higher in patients with clinical stage II disease compared with stage III (P < 0.05). Additionally, patients with elevated NLR had lower survival rates than those with lower NLR (P < 0.05).Conclusion Age, tumor diameter, tumor differentiation, clinical stage, and NLR are factors affecting the prognosis of LAGC patients. Additionally, the combination of these indicators exhibits higher predictive value for the prognosis of the patients.