Study Of Cox Multivariate Regression Analysis Of Prognostic Factors And The Selection Of Reasonable Operation For Locally Advanced Gastric Cancer

ObjectiveLocally advanced gastric cancer refers to T3 and T4 gastric cancer of the tumor has crossesd the serosal layer and extends to adjacent organs without peritoneal, hematogenous, and/or distant lymph node metastasis. This kind of gastric cancer occupy the majority of gastric cancer in our country. So how to evaluated to prognosis an to standard the management is one of focus of current gastric cancer study. This study was carried our to study the regular pattern of Cox prognostic analysis and the selection of reasonable operation, in order to guide the management of locally advanced gastric cancer.Material and methods869 patients of gastric cancer were selected for this study, in which 540 patients with lymph node collection more than 15 were selected to study the Cox prognostic analysis and lymphtic dissection operation. 186 patients without pancreatic infiltration were selected to evaluated the operation of splenectomy and pancreaosplenectomy. 63 patients of No.10 and No.11 lymph node collection more than 0 were selected to study the factors of No.10 and No.11 lymph node metastasis. Then 329 patients without No.10 and No.11 lymph node metastasis were grouped according the result factors, to evaluated the prophylaxis splenectomy of T3 and T4 gastric cancer.ResultsThe 5-years survival rate of the whole group was 32.03%, and 41.96% for T3 gastric cancer, 12.90% for T4 gastric cancer. Univariate analysis showed significant differences in survival among the categories of location, diameter,macroscopic type, depth of invasion, organ invasion, curability, gastrectomy method, organ dissection, , lymphatic invasion, UICC N classification, JCGC N classification, metastasis rate classification and our N classification. Mutilvariate analysis revealed the higher relative hazard for our N classification, depth of invasion and macroscopic type. Also, Univariate analysis showed significant differences in No. 10, 11 lymph node metastasis among the categories of depth of invasion, pancreatic invasion, P, growth type, lymphatic invasion, No.2, 3, 4, 6, 7, 8, 9 lymph node metastasis. And Mutilvariate analysis revealed the higher relative hazard for No.2, 4 lymph node metastasis, growth type. Cancer of invasive, No.2, 4 lymph node metastasis (+) and IIIa> Illb phase gastric cancer showed a superior 5-years survival when splenectomy was done. And II phase gastric cancer showed a superior 5-years survival when preservative-splenectomy was done.Conclusion1. Our N classification, depth of invasion and macroscopic type were the single prognostic factor of locally advanced gastric cancer2. Cancer of invasive, No.2, 4 lymph node metastasis (+) and Illa^ Illb phase gastric cancer showed a superior 5-years survival when splenectomy was done.