| Objective:Analyze the relationship between disease-free survival time(DFS)in patients with Locally advanced gastric cancer after radical operation and clinical and pathological factors including : gender,age,tumor location,tumor size,depth of invasion,number of lymph nodes in the surgery,number of positive lymph nodes,lymph nodes metastasis rate(MLR),clinical pathologic stage,pathological differentiation,the nerve or vascular invasion,preoperative hemoglobin value,red cell distribution width and neutrophil-to-lymphocyte ratio.Disscuss the relationship between recurrence or metastasis site and primary tumor site.Observe the influence to DFS by accomplishing adjuvant chemotherapy(>4cycles).The aim is to provide determining prognostic factors and treatments for patients with locally advanced gastric cancer.Methods:Collecting 133 patients in first affiliated hospital of dalian medical university from January 2009 to December 2015 through the electronic medical record system.All patients underwent radical resection and postoperative pathology were diagnosised to be locally advanced gastric cancer.All patients were comfired to be recurrenced by clinical,imaging or pathological.No neoadjuvant therapy were accepted.Recording the different clinical features,postoperative adjuvant chemotherapy and the recurrence or metastasis site of the patients in the period from operation time up to first recurrence.Analyzing DFS and the relationship between postoperative adjuvant chemotherapy and it,analyzing the correlation between recurrence or metastasis site and primary tumor site.Results:1.Relation between clinical characteristics and DFS Among 133 patients 92 cases were male patients(69.2%),41 cases were female patients(30.8%);53 cases were younger than 60 years(39.8%),80 cases were older than 60 years(60.2%);59 cases accepted postoperative adjuvant chemotherapy less than 4 cycles(44.4%),74 cases accepted postoperative adjuvant chemotherapy more than 4 cycles(55.6%);74 cases were Pathology of poorly differentiated(55.6%),59 cases were Pathology of middle to well differentiated(44.4%);T1 1 case,T2 20 cases,T3 6 cases,T4 106 cases;67 cases had positive lymph nodes>5,66 cases had positive lymph nodes<5;68 cases had lymph nodes in the surgery>19,65 cases had lymph nodes in the surgery<19;10 cases were stage IB,28 cases were stage II,95 cases were stage III;31 cases with vascular invasion;21 cases with nerve invasion;36 cases had RDW>0.14,97 cases had RDW<0.14.Univariate analysis showed DFS had a relationship with numbers of positive lymph nodes,vascular and nerve invasion,postoperative adjuvant chemotherapy,P<0.05;Multi-factor analysis showed DFS had a relationship with the value of RDW and nerve invasion,P<0.05.2.The recurrence sites and the relationship between it and primary tumor site1)recurrence sites: among 133 cases,47 cases were local recurrence(35.3%);48cases were peritoneal recurrence(36.1%);among the distant metastasis 28 cases were liver metastasis(21.1%),5 cases were lung metastasis(3.8%),20 cases were other forms of metastasis,including 4 abdominal wall metastasis,4 superaclavicular lymph node metastasis,5 adrenal metastasis,2 bone metastasis,1 bone marrow metastasis,1Bladder metastasis,1 Ureteral metastasis,1 pelvic metastasis,1 pleural metastasis;11cases were multiple metastasis.2)The constituent ratio of local recurrence,peritoneal recurrence,liver metastasis,lung metastasis,other forms of metastasis and multiple metastasis in patients whose tumor site were Upper stomach(fundus and body of stomach,cardia)was no statistical significance compare to the ratio of local recurrence,peritoneal recurrence,liver metastasis,lung metastasis,other forms of metastasis and multiple metastasis in patients whose tumor site were lower stomach(pylorus and antrum of stomach)(The value of P were all>0.05).Therefore,it couldn`t say that there was a relationship between recurrence or metastasis site with primary tumor site.3.Relationship between postoperative adjuvant chemotherapy and DFS Patiens were grouping by cycles of postoperative adjuvant chemotherapy(4cycles),those who took less than 4 cycles were classified to the group that didn`t finish postoperative adjuvant chemotherapy.Among 133 cases,74 cases had finished postoperative adjuvant chemotherapy,the median DFS was 15 months,while 59 cases hadn`t finished,the median DFS was 12 months.The results showed a difference between two groups(P=0.035),prompting that postoperative adjuvant chemotherapy would help lengthen DFS.Conclsion :1.The number of positive lymph nodes,the value of preoperative RDW,nerve and vascular invasion are negative prognostic factors for patients with locally advanced gastric cancer after radical operation.2.There wasn`t a relationship between recurrence or metastasis site with primary tumor site.3.Postoperative adjuvant chemotherapy is benefical to the prolongation of DFS. |
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