摘要
背景与目的:胃鳞状细胞癌(GSCC)是一种罕见的胃恶性肿瘤,目前缺少对该类患者的大样本临床数据研究,手术治疗的预后价值仍不明确。因此,本研究探讨手术治疗对GSCC患者预后的影响。方法:提取SEER数据库中2000—2019年病理确诊为GSCC患者的临床资料,分析手术治疗对GSCC患者的总生存(OS)与肿瘤特异生存(CSS)的影响,并分析GSCC患者OS与CSS的影响因素以及手术治疗对不同临床病理特征GSCC患者的价值。结果:共纳入334例GSCC患者,其中83例(24.85%)接受手术治疗,251例(75.15%)未接受手术治疗。经1∶1倾向评分匹配均衡基线资料后,每组各81例。生存分析结果显示,手术组的5年OS率(32.07%vs.11.08%,χ^(2)=20.30,P<0.001)与CSS率(41.93%vs.18.45%,χ^(2)=17.10,P<0.001)均明显优于非手术组。Cox多因素分析显示,婚姻状况、病理分化程度、SEER分期、手术治疗、放疗是GSCC患者的OS与CSS的独立影响因素(均P<0.05)。进一步根据临床病理特征进行分层分析显示,行手术治疗的已婚(HR=0.42,95%CI=0.25~0.70,P=0.001)、高分化(HR=0.09,95%CI=0.01~0.84,P=0.035)、肿瘤局限(HR=0.33,95%CI=0.17~0.65,P=0.001)、放疗(HR=0.35,95%CI=0.21~0.58,P<0.001)患者的OS明显提高;行手术治疗的已婚(HR=0.44,95%CI=0.25~0.78,P=0.005)、高分化(HR=0.09,95%CI=0.01~0.84,P=0.035),肿瘤局限(HR=0.34,95%CI=0.15~0.75,P=0.007)、放疗(HR=0.31,95%CI=0.18~0.55,P<0.001)患者的CSS明显提高。结论:手术治疗能有效改善GSCC患者的预后,尤其是已婚、病理分化程度为高分化、肿瘤局限、接受放疗的GSCC的患者为手术治疗的最佳受益人群。
Background and Aims:Gastric squamous cell carcinoma(GSCC)is a rare malignant tumor of the stomach.There is a lack of large-scale clinical data studies on this patient population,and the prognostic value of surgical treatment remains unclear.Therefore,this study was conducted to investigate the impact of surgical treatment on the prognosis of GSCC patients.Methods:The clinical data of GSCC patients pathologically diagnosed between 2000 and 2019 were extracted from the SEER database.The impact of surgical treatment on the overall survival(OS)and cancer-specific survival(CSS)of GSCC patients were analyzed,and the influencing factors for OS and CSS,as well as the value of surgical treatment for GSCC patients with different clinicopathologic characteristics,were determined.Results:A total of 334 GSCC patients were included,among whom 83(24.85%)underwent surgical treatment,while 251(75.15%)did not.After 1:1 propensity score matching to balance baseline data,each group consisted of 81 patients.Survival analysis showed that the 5-year OS rate(32.07%vs.11.08%,χ^(2)=20.30,P<0.001)and CSS rate(41.93%vs.18.45%,χ^(2)=17.10,P<0.001)in the surgery group were significantly better than those in the non-surgery group.Cox multivariate analysis indicated that marital status,pathological differentiation,SEER stage,surgical treatment,and radiotherapy were independent factors for OS and CSS in GSCC patients(all P<0.05).Further stratified analysis based on clinicopathologic characteristics showed that the OS was significantly improved in those married(HR=0.42,95%CI=0.251-0.70,P=0.001),with highly differentiated tumor(HR=0.09,95%CI=0.01-0.84,P=0.035),with localized tumor(HR=0.33,95%CI=0.17-0.65,P=0.001),and receiving radiotherapy(HR=0.35,95%CI=0.21-0.58,P<0.001)who underwent surgery.Similarly,CSS was significantly improved in those married(HR=0.44,95%CI=0.25-0.78,P=0.005),with highly differentiated tumor(HR=0.09,95%CI=0.01-0.84,P=0.035),with localized tumor(HR=0.34,95%CI=0.15-0.75,P=0.007),and receiving radiotherapy(HR=0.31,95%CI=0.18-0.55,P<0.001)who underwent surgery.Conclusion:Surgical treatment can effectively improve the prognosis of GSCC patients.Particularly,those who are married,have highly differentiated tumors and localized tumors,and receive radiotherapy are the best beneficiaries of surgical treatment.
作者
陈鑫明
赵平武
唐红
何运胜
彭宣福
黄坤
赵攀
刘洋
CHEN Xinming;ZHAO Pingwu;TANG Hong;HE Yunsheng;PENG Xuanfu;HUANG Kun;ZHAO Pan;LIU Yang(Department of General Surgery,Mianyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine,Mianyang,Sichuan 621000,China;Department of Pathology,the Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2024年第7期1133-1141,共9页
China Journal of General Surgery
基金
四川省中医药管理局科学技术研究专项基金资助项目(2021MS268)。
关键词
胃肿瘤
癌
鳞状细胞
外科手术
预后
SEER规划
倾向性评分
Stomach Neoplasms
Carcinoma,Squamous Cell
Surgical Procedures,Operative
Prognosis
SEER Program
Propensity Score
