基于SEER数据库的老年晚期胃癌预后因素分析

Analysis of prognostic factors of elderly patients with advanced gastric cancer based on SEER database

摘要:

目的： 探讨影响老年晚期胃癌预后的临床因素。方法： 通过SEER*Stat软件提取SEER数据库2010至2016年经病理诊断的、65~85岁的晚期胃癌患者，通过单因素和多因素Cox回归分析，探讨影响老年晚期胃癌患者预后的临床因素。结果： Cox多因素回归显示：75~85岁的HR为1.33（95%CI=1.20~1.49，P=0.000）；中分化、高分化的HR分别为0.82（95%CI=0.71~0.93，P=0.003）、0.61（95%CI=0.43~0.86，P=0.005）；肿瘤大小31~60 mm、61~90 mm、≥91 mm的HR分别为1.16（95%CI=1.01~1.33，P=0.035）、1.2（95%CI=1.01~1.42，P=0.035）、1.53（95%CI=1.26~1.85，P=0.000）。随着LNR的增加，其HR均增加（P≤0.001）；骨转移的HR为1.4（95%CI=1.08~1.81，P=0.01），多个转移部位的HR为1.54（95%CI=1.30~1.83，P=0.000）；多原发癌的HR为0.66（95%CI=0.48~0.92，P=0.013）。结论： 影响老年晚期胃癌的独立预后因素包括年龄、分化程度、肿瘤大小、LNR、肿瘤数量、转移部位，但是由于LNR信息和获取依赖手术的实施，而晚期胃癌手术比例低，故其在晚期胃癌预后预测中的实际应用价值值得商榷。

Abstract:

Objective: To investigate the clinical factors affecting the prognosis of elderly patients with advanced gastric cancer. Methods: SEER*Stat software was used to extract patients with advanced gastric cancer aged 65-85 years with pathological diagnosis from 2010 to 2016.The univariate and multivariate Cox regression analysis were used to investigate the clinical factors affecting the prognosis of elderly patients with advanced gastric cancer. Results: Cox multivariate regression showed that the HR for 75-85 years was 1.33 (95%CI=1.20-1.49, P=0.000); the HR for middle and high differentiation was 0.82 (95%CI=0.71-0.93, P=0.003), and 0.61 (95%CI=0.43-0.86, P=0.005); HR of tumor size in 31-60 mm, 61-90 mm, ≥91 mm were 1.16 (95%CI=1.01-1.33, P=0.035), 1.2 (95%CI=1.01-1.42, P=0.035), and 1.53 (95%CI=1.26-1.85, P=0.000). With the increase of LNR, the HR also increased (P≤0.001); the HR of bone metastases was 1.4 (95%CI=1.08-1.81, P=0.01), and the HR of multiple metastatic sites was 1.54 (95%CI=1.30-1.83, P=0.000); and the HR for multiple primary cancer was 0.66 (95%CI=0.48-0.92, P=0.013). Conclusion: Independent prognostic factors affecting advanced gastric cancer in the elderly include age, degree of differentiation, tumor size, LNR, number of tumors, and metastatic sites. However, because LNR information and access are dependent on the implementation of surgery, but the proportion of advanced gastric cancer surgery is low, so it’s practical application value in the prognosis prediction of advanced gastric cancer is debatable.