Retrospective Study Of The Clinicopathological Data In Gastric Cancer

Objective:To analyze the clinical and pathological features of patients with gastric cancer, evaluate the role of imaging in preoperative staging, explore the prognosis factors of patients and to provide a reliable basis for individualized treatment for patients.Method:A total of385cases of gastric cancer were operated, the data were collected retrospectively from a period between Jan2004and Dec2010at Tianjin Medical University General Hospital. The clinical information of the cases include the sex, age, clinical symptoms, the content of the hemoglobin, platelet, tumor markers, radiographic examination, operation treatment, pathological characteristics, chemotherapy. The effects of sex, age, preoperative anemia, PLT elevating, CEA,CA19-9, operation method, depth of tumor invasion, lymph node and distant metastasis, TNM staging, tumor location, tumor diameter, histological type, degree of differentiation, intravascular cancer embolus, margin status, chemotherapy were analyzed.Results:1. Clinical results:Among385cases,269were men and116were women, the average age was61.0±12years. The most common symptoms were abdominal pain, abdominal distention and weight loss.313(81.3%) patients were received radical operation,277(71.9%) patients were received distal subtotal gastrectomy; the adjuvant therapy was added with intraoperative chemotherapy in173(44.9%) cases, postoperative chemotherapy in233(60.5%) cases.2. Preoperative diagnose:Positive rates of CEA、CA19-9and AFP were17.5%、16.4%and4.8%respectively, positive rate was32.8%by combined detection; it was highly suspected of liver metastasis when the AFP increased; the preoperative imaging data showed that the preoperative plain CT scan and contrast CT staging was moderately consistent with the pathological staging(0.4<K<0.7).3. Pathological results:The patients with T3and T4stage gastric cancer accounted for67.3%(259patients),lymph node metastasis were found in239(62.1%) patients, distant metastasis were detected in53(13.8%) patients.99,55,179,52cases were in stages Ⅰ, Ⅱ,Ⅲ, Ⅳ of TNM staging respectively. The majority of gastric cancer was located in the gastric antrum, and the diameter of the tumor was from0.5to12cm;in histological type, the adenocarcinoma accounted for75.3%,most of which were poorly differentiated carcinoma(75.3%).Cancer embolus accounted for52(13.5%) cases, and45(11.7%) cases with positive margin.4. Follow-up status:340patients completed the follow-up among all the385patients and the follow-up rate was88.3%.5. Prognostic factors:Univariate analysis showed that the predictors of survival in gastric cancer patients were PLT elevating, CEA, combined detection of tumor markers, radical resection, depth of tumor invasion,lymph node and distant metastasis, TNM staging, tumor diameter, histological type, degree of differentiation, intravascular cancer embolus, margin status and postoperative chemotherapy(P<0.05). Multivariate analysis showed that TNM staging, lymph node metastasis, radical resection, PLT elevating, postoperative chemotherapy had a significant relation with the prognosis of patients (P<0.05).Conclusion:1. The gastric cancer are most common in the middle and old aged people, especially in the men. The nonspecific symptoms are abdominal pain, abdominal distention and weight loss, which may not detected during the early stage, so it is difficult for early diagnosis, and it is already in the advanced stage even though being diagnosed.2. The detectable rates of single CEA、CA19-9、AFP are low in gastric cancer, while the combined detection could help the diagnosis. The increased AFP showed the possibility of liver metastasis. Among all the image examination, CT has the most value in the diagnosis of gastric cancer, which is more effective and accurate for the preoperative staging.3. Univariate analysis shows that the predictors for gastric cancer patients are PLT elevating. CEA, combined detection of tumor markers, radical resection, depth of tumor invasion, lymph node and distant metastasis, TNM staging, tumor diameter, histological type, degree of differentiation, intravascular cancer embolus, margin status, postoperative chemotherapy. 4. Multivariate analysis shows that TNM staging, lymph node metastasis, radical resection, postoperative chemotherapy,PLT elevating are independent prognosis factor for gastric cancer patients.5. In conclusion, the most appropriate treatment should be selected according to preoperative TNM staging, radical excision with adjuvant chemotherapy is main therapy, which could improve the5-year survival rate in gastric cancer patients.