【作者】 李涛；

【导师】 张长乐；

【作者基本信息】 安徽医科大学 ， 普外科， 2022， 硕士

【摘要】 目的血清肿瘤标志物已广泛应用于胃癌患者的诊断和随访。然而,很少有研究通过多个血清肿瘤指标建立统计模型来评估胃癌患者的预后。方法从2016年10月到2018年4月,共有1236名在安徽医科大学第一附属医院胃肠外科接受手术治疗,并且术后病理证实是I期至III期胃癌患者被纳入我们的研究。分析血清肿瘤标志物与患者临床和病理资料之间的相关性。根据COX回归分析的结果,建立了预测胃癌预后的评分系统。不同临床分期的胃癌也比较了总生存率的差异。结果单因素分析的结果发现,年龄、TNM临床分期、T和N分期、肿瘤部位、分化程度、Borrmann类型、肿瘤直径和4种血清肿瘤标志物是总生存率的预后影响因素(P<0.05),临床分期、肿瘤大小、AFP、CEA、CA125、CA19-9(P<0.05)是总生存率的独立预后影响因素。根据统计模型得出的评分结果,我们发现评分高的患者生存时间差(P<0.05)。此外,在Ⅰ期胃癌中,0-3分患者的3年总生存率分别为96.85%、95%、85%和80%。在II期胃癌中,0-4分患者的3年总生存率分别为88.6%、76.5%、70.5%、65.5%和60%。至于III期胃癌,0-6分的3年总生存率分别为70.9%、68.3%、64.1%、50.9%、38.4%、18.5%和5.2%。我们还分析了不同评分患者的平均总生存期。Ⅰ期患者的平均总生存期为55.980个月。Ⅱ期平均总生存期为51.550个月。Ⅲ期平均总生存期为39.422个月。结论4种血清肿瘤标志物是胃癌患者预后的独立影响因素。基于这四种肿瘤标志物构建的评分系统可以有效预测胃癌患者的预后。更多还原

【Abstract】 Objective Preoperative serum tumor markers have been widely used in the diagnosis and treatment of gastric cancer patients.However,few studies have evaluated the prognostic of gastric cancer patients by establishing statistical models with multiple serum tumor indicators.Methods From October 2016 to April 2018,a total of 1236 patients with stage I to III gastric cancer after surgery were included in our study.The relevance between serum tumor markers and clinical and pathological data were analyzed.We established a statistical model to predict the prognosis of gastric cancer based on the results of COX regression analysis.OS was also compared in different stages of gastric cancer.Results A total of 1236 patients were recruited into our study.The univariate analysis found that age,clinical stage,T and N stage,tumor location,differentiation,Borrmann type,size,and 4 serum tumor markers were prognostic factors of overall survival(OS)(p < 0.05)and it was showed that clinical stage,tumor size,AFP,CEA,CA125,CA19-9(p < 0.05)were independent prognostic factors for OS.According to the scoring results obtained from the statistical model,we found that patients with high score had poor survival time(p < 0.05).Futhermore,In stage Ⅰ,the 3-year OS for scores 0-3 ranged from 96.85%,95%,85%,and 80 %.In stage Ⅱ,The 3-year OS for scores 0-4 were 88.6%,76.5%,90.5%,65.5% and 60%.As for stage Ⅲ,the 3-year OS for scores 0-6 were 70.9%,68.3%,64.1%,50.9%,38.4%,18.5% and 5.2%.We also analyzed the mean survival of patients with different scores.For stage Ⅰ patients,the mean OS was 55.980 months.In stageⅡ,the mean OS was 51.550 months.The mean OS of stage Ⅲ was 39.422 months.Conclusion Serum tumor markers are independent influencing factors for the prognosis of gastric cancer patients.A scoring system constructed based on these four medium tumor markers could effectively predict the prognosis of patients with gastric cancer.更多还原