Clinicopathological Features And Prognostic Risk Factors Of Gastric Cancer Patients Undergoing Gastrectomy

OBJECTIVThe clinicopathological features and prognostic risk factors of gastric cancer patients undergoing gastrectomy are systematically analyzed to explore the risk factors influencing postoperative overall survival time,so as to provide reference to the diagnosis and treatment of patients with gastric cancer.METHODSThe clinicopathological data of gastric patients undergoing gastrectomy in The First Hospital of Lanzhou University from January 2018 to July 2019 are retrospectively analyzed.The gender,age,blood routine,biochemistry,tumor markers,blood type,pathological data and prognostic data of the population are described and analyzed.To explore the risk factors influencing the overall survival time.RESULTS1.In this study,the proportion of male to female patients undergoing gastrectomy is 3.5:1,with an average age of 59.23 years old,59.79 years old for males and 59.27 years old for females.The pathological differentiation degree is mainly low（82.4%）,the pathological type is mainly adenocarcinoma（97.8%）,the depth of tumor invasion is mainly T4a（55%）,and the pathological TNM stage is stage Ⅲ（56.1%）.Postoperative follow-up time rang from 1 to 47 months,with a median follow-up time of 27.13 months.The median survival time is 31（14,39）months,1-year survival rate is 76.8%,2-year survival rate is 61.2%.Up to the final follow-up time,157 cases（42.5%）died and 212 cases（57.5%）survived.2.The univariate analysis results affecting the overall survival time of gastric cancer patients show that the effect of LSR on the overall survival time is statistically different（HR=1.627,95%CI 1.228～2.155,P=0.001）;Among the tumor markers,CA199（HR=1.002,95%CI 1.001～1.002,P=0.001）,CEA（HR=1.003,95%CI 1～1.006,P=0.031）are statistically different on survival time;In the pathological type,in contrast to the adenocarcinoma,the effect of overall survival time is varied by signet cell carcinoma（HR=10.945,95%CI 3.436～34.868,P<0.001）;In the p TNM,in contrast to phase IA,Phase ⅢA（HR=2.23,95%CI 1.22～4.078,P=0.009）,Phase ⅢB（HR=2.537,95%CI 1.357～4.744,P=0.004）,Phase ⅢC（HR=3.679,95%CI1.977～6.847,P <0.001）,Phase Ⅳ（HR=8.815,95%CI 3.354～23.171,P<0.001）is statistically different in overall survival time;In contrast to the T1 a,T4a（HR=2.786,95%CI 1.359～5.712,P=0.005）,T4b（HR=2.822,95%CI 1.023～7.789,P=0.045）is statistically different in overall survival time;In contrast to the N0,N1（HR=2.424,95%CI 1.434～4.096,P=0.001）,N2（HR=1.836,95%CI 1.092～3.086,P=0.022）,N3a（HR=2.402,95%CI 1.472～3.919,P<0.001）,N3b（HR=3.69,95%CI 2.266～6.009,P<0.001）affected overall survival time statistically different.In distant transfer,the effect of M1 on overall survival is compared to M0 is statistically different（HR=4.465,95%CI 1.958–10.182,P<0.001）.No statistical difference between the other variables on overall survival time（P>0.05）.3.Multivariate analysis affecting the overall survival time of gastric cancer patients: pathological types,p TNM,CA199,CEA and LSR are included to construct a multivariate COX proportional risk model.Results: In pathological type,in contrast to the adenocarcinoma,the effect of signet cell carcinoma on overall survival time is statistically different（HR=12.815,95%CI 3.865～42.486,P<0.001）;In the p TNM,in contrast to the Phase IA,Phase ⅢA（HR=2.013,95%CI 1.092～3.711,P=0.025）,PhaseⅢB（HR=2.194,95%CI 1.161～4.147,P=0.016）,Phase ⅢC（HR=3.164,95%CI1.678～5.965,P<0.001）,Phase Ⅳ（HR=6.087,95%CI 2.038～18.185,P=0.001）are statistically different on overall survival time;The effect of LSR on overall survival time is statistically different（HR=1.429,95%CI 1.062～1.924,P=0.018）.No statistical difference between the other variables on overall survival time（P>0.05）.4.Multivariate analysis affecting the overall survival time of gastric cancer patients: pathological types,p TNM,CA199,CEA and LSR are included to construct a multivariate COX proportional risk model.Results: In pathological type,in contrast to the adenocarcinoma,the effect of signet cell carcinoma on overall survival time is statistically different（HR=12.815,95%CI 3.865～42.486,P<0.001）;In the p TNM,in contrast to the Phase IA,Phase ⅢA（HR=2.013,95%CI 1.092～3.711,P=0.025）,PhaseⅢB（HR=2.194,95%CI 1.161～4.147,P=0.016）,Phase ⅢC（HR=3.164,95%CI1.678～5.965,P<0.001）,Phase Ⅳ（HR=6.087,95%CI 2.038～18.185,P=0.001）are statistically different on overall survival time;The effect of LSR on overall survival time is statistically different（HR=1.429,95%CI 1.062～1.924,P=0.018）.No statistical difference between the other variables on overall survival time（P>0.05）.5.Gender,age,RBC,HGB,HCT,WBC,LYC,PLR,AST,ALT,ALB,AGR,ALP,GGT,UA,TG,HDL-C,lymph node metastasis and p TNM stage in patients undergoing gastrectomy in LSR<1.21 group and LSR≥1.21 group have statistical significance（P<0.05）.LSR is correlated with overall survival time of patients underwent radical gastrectomy for gastric cancer,and the overall survival time of patients in LSR<1.21 group is longer than that in LSR≥1.21 group（P=0.016）.CONCLUSIONS1.In this study,the gastric patients undergoing gastrectomy are more male than female,and the onset age is 60 years.The pathological types are mainly poorly differentiated adenocarcinoma.The depth of tumor invasion is T4 a,and the p TNM stage is stage Ⅲ.2.Signet cell carcinoma,N1,N3 b,M1,ⅢA,ⅢB,ⅢC,IV,preoperative LSR are independent risk factors affecting overall survival time of gastric patients undergoing gastrectomy.3.Preoperative LSR plays an important role in the prognosis of gastric patients undergoing gastrectomy,and has a certain correlation with clinicopathological features.