Maximum gastric cancer diameter as a prognostic indicator: univariate and multivariate analysis.
Maximum gastric cancer diameter as a prognostic indicator: univariate and multivariate analysis.
复制标题
胃癌最大直径作为预后指标：单变量和多变量分析。
DOI：
--
复制
发表时间：
2003
期刊：
影响因子：
--
通讯作者：
A. Tocchi
中科院分区：
文献类型：
--
作者：
Andrea Giuliani;A. Caporale;M. D. Bari;M. Demoro;P. Gozzo;M. Corona;M. Miccini;T. Ricciardulli;A. Tocchi
提示胃癌的预后因素中没有比淋巴结受累或胃壁浸润深度更强的因素。本文评价了固定切除标本上测量的最大肿瘤直径（MTD）值对胃癌患者疾病进展程度和预后的影响。临床病理资料回顾性检索122例患者接受根治性胃切除术的记录。患者的MTD值分组如下：MTD 1，最大26 mm; MTD 2，在26和50 mm之间; MTD 3，超过50 mm。三组在5年生存率方面有显著差异（MTD1：54%，MTD2：31%，MTD3：20%; p = 0.00027），此外，它们在胃切除术类型方面存在显著差异（p = 0.021）、壁深浸润（p = 0.000）、淋巴管微浸润（p = 0.014）、神经周围微浸润（p = 0.017）、间质反应（p = 0.025）和分期（p = 0.035）。ROC曲线分析确定了淋巴结受累的最佳MTD阈值为32 mm（敏感性= 56.6%;特异性= 60.9%;阳性预测值= 52.6%;阴性预测值= 64.6%）。Logistic回归分析显示，壁浸润深度是与MTD值相关的唯一自变量（p = 0.0005）。多因素分析显示独立的预后危险因素为性别（p < 0.0025）、受累淋巴结数目（p < 0.001）和MTD（p < 0.001）。结论：胃癌最大肿瘤直径值可能是一个比以前认为的具有更大预后意义的因素。
It was suggested that there are no stronger prognostic factors in gastric cancer than nodal involvement or depth of wall invasion. The present paper evaluated the influence of maximum tumor diameter (MTD) value, measured on fixed resected specimens, on the extent of disease progression and the outcome in gastric cancer patients. Clinicopathological data were retrospectively retrieved from records of 122 patients who underwent curative gastrectomy. The patients' MTD values were grouped as follows: MTD1, up to 26 mm; MTD2, between 26 and 50 mm; and MTD3, over 50 mm. The three groups evidenced significant differences with regard to 5 year survival (MTD1: 54%, MTD2: 31%, MTD3: 20%; p = 0.00027), furthermore they were significantly different with respect to the type of gastrectomy (p = 0.021), depth wall invasion (p = 0.000), lymphatic microinvasion (p = 0.014), perineural microinvasion (p = 0.017), stromal reaction (p = 0.025), and stage (p = 0.035). ROC curve analysis individuated a best accurate MTD threshold value for nodal involvement of 32 mm (sensitivity = 56.6%; specificity = 60.9%; positive predictive value = 52.6%; negative predictive value = 64.6%). The logistic regression analysis suggested that the depth of wall invasion was the only independent variable associated with MTD value (p = 0.0005). Multivariate analysis showed that independent prognostic risk factors were sex (p < 0.0025), number of involved nodes (p < 0.001) and MTD (p < 0.001). In conclusion, the maximum tumor diameter value of gastric cancer may be a factor with greater prognostic implications than previously believed.