目的 探讨影响Ⅳ期胃癌预后的相关因素.方法 回顾性总结中山大学肿瘤防治中心2000-2010年收治的有完整随访资料的Ⅳ期胃癌患者248例.选择年龄、性别、体质量减轻、血红蛋白、癌胚抗原(CEA)、糖蛋白抗原(CA19-9)、Borrmann分型、肿瘤部位、肿瘤大小、病理类型、转移部位、治疗模式共12项临床病理参数作为观察指标.用Kaplan-Meier法绘制生存曲线,计算中位生存时间(MST),用Log-rank检验行单因素分析,Cox回归风险比例模型行预后的多因素分析.结果 全组患者MST为254 d,单因素分析表明,性别、Borrmann分型、治疗模式是影响Ⅳ期胃癌预后的相关因素,而Cox回归模型显示,上述3个指标也是影响本组Ⅳ期胃癌预后的独立因素(P＜0.05).结论 治疗模式是影响Ⅳ期胃癌生存的重要独立因素,姑息化疗联合姑息手术的转化医学模式有助于改善Ⅳ期胃癌患者的预后.%Objective To investigate the related prognostic factors of stage Ⅳ gastric cancer.Methods The clinical data of 248 patients with stage Ⅳ gastric cancer and intact follow up data in the Tumor Prevention and Treatment Center of Sun Yat-Sen University from 2000 to 2010 were retrospectively summarized.The twelve clinicopathological parameters served as the observation indicators,including age,sex,body mass reduction,H b,CEA,CA19-9,Borrmann type,tumor location,tumor size,pathological pattern,operative mode,metastatic sites and therapeutic model.The survival curve was drawn by using the Kaplan-Meier method.The median survival time was calculated.The univariate analysis was conducted with Log-rank test.The prognosis multivariate analysis was conducted by the Cox's proportional hazards regression analysis.Results MST in the patients of whole group was 254 d.The univariate analysis showed that sex,Borrmann type and therapeutic mode were the related factors afecting gastric cancer prognosis,while the Cox regression model revealed that above 3 indicators were also independent factors affecting the prognosis of the patients with stage Ⅳ gastric cancer in this group(P＜0.05).Conclusion The treatment mode is an important independent factor affecting the survival of stage Ⅳ gastric cancer,the translational medicine model of palliative chemotherapy combined with palliative operation conduces to improve the prognosis in the patients with stage Ⅳ gastric cancer.
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