| Objective:Due to severe local invasion or distant metastasis,stage T4 b gastric cancer often has a poor prognosis due to complicated prognostic factors.At present,there are relatively few studies on the surgical treatment of T4 b gastric cancer,and its therapeutic effect is still controversial.The purpose of this study was to evaluate the value of surgical and non-surgical treatment for stage T4 b gastric cancer,and to explore the independent risk factors affecting the prognosis of stage T4 b gastric cancer,so as to provide reasonable and effective treatment programs for patients and provide reference materials for improving the prognosis and prolonging the survival of patients.Method:The clinical data of 83 patients with stage c T4 b gastric cancer who received treatment in Bethune First Hospital of Jilin University from January 2018 to December 2021 were retrospectively analyzed,and the complete follow-up data were obtained through telephone follow-up.spss 26.0 was used to process the data.First of all,according to patients’ treatment methods,33 patients receiving surgical treatment were classified as surgical treatment group,and 50 patients receiving chemotherapy or other treatment methods were classified as non-surgical treatment group,for survival analysis and comparison.Then,for some special patients with stage T4 b gastric cancer,the 2-year survival rate of patients in the operation group and the non-operation group under different operation methods,different N stages and tumor length and diameter was stratified to evaluate the value of surgical treatment.In addition,Kaplan-Meien method was used to analyze the influence of 12 variables,including age,gender,BMI,tumor length,location,degree of differentiation,N stage,anemia,platelet count after admission,tumor markers CEA,CA199,and immunohistochemical index Ki-67,on the prognosis of stage T4 b gastric cancer.And draw the survival time curve;Finally,single factors with statistical significance(P<0.05)were incorporated into Cox regression analysis model for multivariate analysis,and independent risk factors affecting long-term survival of patients with stage T4 b gastric cancer were further screened out(P<0.05).Results:1.The end point of follow-up during the period from discharge to December 20,2022 was death.During the follow-up period,16 patients with stage T4 b gastric cancer were alive,accounting for 19.3%.The median survival time was 8 months.The 2-year survival rate was 19.6%.2.Comparison of survival analysis between the T4 b gastric cancer operation group and the non-operation group,the 2-year survival rate was 18.0% vs 22.0%,there was no statistical significance in the long-term prognosis of stage T4 b gastric cancer after surgery(P=0.951 > 0.05).The 2-year survival rates were 13.9% VS 20.0% VS 28.6%in the groups of stomach + pancreatic body and tail,splenectomy,partial gastrectomy and partial gastrectomy and liver resection.Survival analysis showed statistical significance(P=0.020 < 0.05),suggesting that different surgical methods affected the longterm survival of stage T4 b gastric cancer,and the long-term survival rate of partial gastrectomy + hepatectomy was higher.At different N stages,the 2-year survival rate of T4 b gastric cancer at N0 and N1 stages was 43.8% VS 16.7%.Log-Rank test showed that there was a significant difference in survival rates between the surgery group and the non-surgery group(P=0.027<0.05),but the difference was not significant at N2 and N3(P=0.664>0.05).In addition,the study also found that the 2-year survival rate of T4 b gastric cancer patients with tumor length diameter < 5CM was 47.1% VS 25.0%in the surgery group and the non-surgery group,and the difference was also statistically significant(P=0.039<0.05).For patients with tumor diameter > 5CM,there was no significant difference in survival rate between the surgery group and the non-surgery group(P=0.397>0.05).3.Univariate analysis showed that tumor length diameter,N stage,platelet count after admission,anemia,tumor markers CEA and CA19-9 had significant effects on the long-term prognosis of stage T4 b gastric cancer(P < 0.05).Age,sex,BMI,tumor site,degree of differentiation and Ki-67 had no statistical significance on the long-term prognosis of stage T4 b gastric cancer(P > 0.05).4.The results of multivariate analysis showed that tumor length diameter(P=0.032< 0.05),N stage(P=0.015 < 0.05),anemia(P=0.006 < 0.05)and CEA(P=0.003 < 0.05)were independent risk factors for long-term prognosis of stage T4 b gastric cancer.Conclusion:1.For some patients with stage T4 b gastric cancer,surgical treatment can improve the survival rate of patients when the lesions involve part of the liver,the N stage is in stage N0 or N1,or the tumor length is less than 5CM.2.Tumor length diameter,N stage,anemia and tumor marker CEA are independent risk factors affecting the prognosis of patients with stage T4 b gastric cancer.Comprehensive assessment of these risk factors can provide important reference value for postoperative treatment,monitoring recurrence and evaluating prognosis of patients. |
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