胃癌患者根治性切除术前血脂水平与预后的相关性

doi:10.3969/j.issn.1004-583X.2024.10.004

摘要/Abstract

摘要：

目的探究胃癌(gastric cancer,GC)患者根治性切除术前血脂与临床病理特征及预后的关系。方法回顾性分析于2019年10月至2020年5月就诊于兰州大学第二医院行GC根治性切除术的GC患者307例。比较患者的临床资料,探究患者术前2 周内血脂水平与预后的相关性。结果 307例GC患者随访时间为1~79个月,中位随访时间为 52 个月。截至最终随访时间本研究总共失访72例,最终纳入235 例患者,其中 111例患者死亡。术前总胆固醇(total cholesterol,TC)升高与患者性别、病理T分期(pathological T stage, pT)、病理N分期(pathological N stage, pN)、癌胚抗原(carcinoembryonic antigen, CEA)升高及肿瘤侵犯神经具有相关性(P<0.05)。术前高水平的甘油三酯(triglyceride,TG)与肿瘤最大径、分化程度、神经脉管侵犯、pT、pN及患者身体质量指数相关(P<0.05),低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)升高与患者身体质量指数升高、pT、pN、肿瘤侵犯神经及CEA升高具有相关性(P<0.05)。对235例GC根治术患者进行Cox单因素风险分析发现肿瘤最大径、肿瘤位置、脉管侵犯、神经侵犯、CEA、糖抗原(carcinoembryonic antige, CA)125、CA199、pT、pN、TC、TG及LDL-C均是影响GC根治术后患者总生存期的危险因素(P<0.05)。多因素结果分析显示,排除其他混杂因素后,肿瘤直径、CEA、CA125、CA199、pT、身体质量指数及LDL-C是GC预后的独立危险因素(P<0.05)。结论术前LDL-C可作为预测GC根治性切除术患者预后的独立危险因素。

关键词: 胃肿瘤, 血脂, 预后

Abstract:

Objective To evaluate the correlation of serum lipids before radical gastrectomy for gastric cancer (GC) with clinicopathological characteristics and prognosis. Methods A total of 307 GC patients underwent radical gastrectomy in the Second Hospital of Lanzhou University from October 2019 to May 2020 were retrospectively analyzed. The clinical data were compared to explore the correlation between serum lipids 2 weeks before radical gastrectomy and the prognosis. Results The follow-up time of 307 GC patients was 1-79 months, with a median follow-up time of 52 months. As of the final follow-up time, a total of 72 patients were lost to follow-up in this study, and 235 patients were finally included, of which 111 patients died. The preoperative increase in total cholesterol (TC) was significantly correlated with gender, pathological T stage(pT), pathological N stage(pN), carcinoembryonic antigen (CEA) and neurovascular invasion (P<0.05). High levels of triglyceride (TG) was significantly correlated with tumor maximum diameter, vascular invasion, pathological differentiation, pT, pN, and body mass index (BMI) (P<0.05). The increase in the low-density lipoprotein cholesterol (LDL-C) was significantly correlated with increased BMI, pT, pN,CEA and perineural invasion (P<0.05). Cox univariate risk analysis was performed on 235 GC patients treated with radical gastrectomy. Tumor maximum diameter, tumor location, vascular invasion, nerve invasion, CEA, carbohydrate antigen (CA) 125, CA199, pT, pN, TC, TG and LDL-C were all risk factors for the overall survival after radical gastrectomy (P<0.05). Multivariate analysis showed that after excluding other confounding factors, tumor size, CEA, CA125, CA199, pT, BMI and LDL-C were the independent risk factors for the prognosis of gastric cancer (P<0.05). Conclusion Preoperative LDL-C can be used as an independent factor to predict the prognosis of GC after radical gastrectomy.

Key words: stomach neoplasms, serum lipids, prognosis

中图分类号:

R735.2

赵金匣, 康慧慧, 张垚, 付生军, 孙鹏飞. 胃癌患者根治性切除术前血脂水平与预后的相关性[J]. 临床荟萃, 2024, 39(10): 889-895.

Zhao Jinxia, Kang Huihui, Zhang Yao, Fu Shengjun, Sun Pengfei. Correlation between serum lipids before radical gastrectomy for gastric cancer and the prognosis[J]. Clinical Focus, 2024, 39(10): 889-895.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.10.004

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I10/889

图/表 8

参考文献 23

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项目	TC<4.775 mmol/L组 (n=194)	TC≥4.775 mmol/L组 (n=41)	统计值	P值
年龄(岁)	56.51±0.25	58.10±9.10	t=0.92	0.36
性别[例(%)]
男性女性	169(87.1) 25(12.9)	25(60.9) 16(39.1)	χ²=2.02	0.04
肿瘤最大径(cm)	4.00(3.00,6.00)	3.50(2.50,5.00)	Z=1.40	0.16
分化程度[例(%)]
高中分化低分化	85(43.8) 109(56.2)	23(56.1) 18(43.9)	χ²=1.43	0.15
脉管侵犯[例(%)]
是否	156(80.4) 38(19.6)	28(68.3) 13(31.7)	χ²=1.71	0.09
神经侵犯[例(%)]
是否	133(68.6) 61(31.4)	19(46.3) 22(53.7)	χ²=2.70	0.01
BMI(kg/m²)	21.70±3.18	22.60±2.82	t=1.68	0.07
pT[例(%)]
T₁-T₂ T₃-T₄	47(24.2) 147(75.8)	19(46.3) 22(53.7)	χ²=2.86	0.00
pN[例(%)]
N₀-N₁ N₂-N₃	97(50.0) 97(50.0)	31(75.6) 10(24.4)	χ²=2.99	0.00
CEA(ng/ml)	2.37(1.42, 4.36)	1.73(1.11, 3.20)	Z=2.26	0.02
CA125(U/ml)	11.51(7.93, 17.48)	10.88(8.62, 15.68)	Z=0.33	0.74
CA199(U/ml)	11.59(6.14, 20.43)	8.93(5.79, 18.38)	Z=1.08	0.28

项目	TC<4.775 mmol/L组 (n=194)	TC≥4.775 mmol/L组 (n=41)	统计值	P值
年龄(岁)	56.51±0.25	58.10±9.10	t=0.92	0.36
性别[例(%)]
男性女性	169(87.1) 25(12.9)	25(60.9) 16(39.1)	χ²=2.02	0.04
肿瘤最大径(cm)	4.00(3.00,6.00)	3.50(2.50,5.00)	Z=1.40	0.16
分化程度[例(%)]
高中分化低分化	85(43.8) 109(56.2)	23(56.1) 18(43.9)	χ²=1.43	0.15
脉管侵犯[例(%)]
是否	156(80.4) 38(19.6)	28(68.3) 13(31.7)	χ²=1.71	0.09
神经侵犯[例(%)]
是否	133(68.6) 61(31.4)	19(46.3) 22(53.7)	χ²=2.70	0.01
BMI(kg/m²)	21.70±3.18	22.60±2.82	t=1.68	0.07
pT[例(%)]
T₁-T₂ T₃-T₄	47(24.2) 147(75.8)	19(46.3) 22(53.7)	χ²=2.86	0.00
pN[例(%)]
N₀-N₁ N₂-N₃	97(50.0) 97(50.0)	31(75.6) 10(24.4)	χ²=2.99	0.00
CEA(ng/ml)	2.37(1.42, 4.36)	1.73(1.11, 3.20)	Z=2.26	0.02
CA125(U/ml)	11.51(7.93, 17.48)	10.88(8.62, 15.68)	Z=0.33	0.74
CA199(U/ml)	11.59(6.14, 20.43)	8.93(5.79, 18.38)	Z=1.08	0.28

项目	TG<1.175 mmol/L组 (n=138)	TG≥1.175 mmol/L (n=97)	统计值	P值
年龄(岁)	56.57±10.48	57.09±9.47	t=0.40	0.69
性别[例(%)]
男性女性	101(73.2) 37(26.8)	72(74.2) 25(25.8)	χ²=0.18	0.86
肿瘤最大径(cm)	4.50(3.00,6.00)	3.00(2.15,5.00)	Z=3.69	0.00
分化程度[例(%)]
高中分化低分化	55(39.9) 83(60.1)	53(54.6) 44(45.4)	χ²=2.63	0.03
脉管侵犯[例(%)]
是否	117(84.8) 21(15.2)	67(69.1) 30(30.9)	χ²=2.87	0.00
神经侵犯[例(%)]
是否	104(75.4) 34(24.6)	48(49.5) 49(50.5)	χ²=4.08	0.00
BMI(kg/m²)	21.16±3.06	22.83±2.97	t=4.45	0.00
pT[例(%)]
T₁-T₂ T₃-T₄	25(18.1) 113(81.9)	41(42.3) 56(57.7)	χ²=4.05	0.00
pN[例(%)]
N₀-N₁ N₂-N₃	67(48.6) 71(51.4)	61(62.9) 36(37.1)	χ²=2.17	0.03
CEA(ng/ml)	50(25, 75)	2.35(1.32, 4.28)	Z=0.77	0.44
CA125(U/ml)	2.1(1.29, 3.79)	11.19(7.81, 17.95)	Z=0.44	0.66
CA199(U/ml)	11.69(8.80, 15.91)	10.68(6.02, 20.31)	Z=0.38	0.71

项目	TG<1.175 mmol/L组 (n=138)	TG≥1.175 mmol/L (n=97)	统计值	P值
年龄(岁)	56.57±10.48	57.09±9.47	t=0.40	0.69
性别[例(%)]
男性女性	101(73.2) 37(26.8)	72(74.2) 25(25.8)	χ²=0.18	0.86
肿瘤最大径(cm)	4.50(3.00,6.00)	3.00(2.15,5.00)	Z=3.69	0.00
分化程度[例(%)]
高中分化低分化	55(39.9) 83(60.1)	53(54.6) 44(45.4)	χ²=2.63	0.03
脉管侵犯[例(%)]
是否	117(84.8) 21(15.2)	67(69.1) 30(30.9)	χ²=2.87	0.00
神经侵犯[例(%)]
是否	104(75.4) 34(24.6)	48(49.5) 49(50.5)	χ²=4.08	0.00
BMI(kg/m²)	21.16±3.06	22.83±2.97	t=4.45	0.00
pT[例(%)]
T₁-T₂ T₃-T₄	25(18.1) 113(81.9)	41(42.3) 56(57.7)	χ²=4.05	0.00
pN[例(%)]
N₀-N₁ N₂-N₃	67(48.6) 71(51.4)	61(62.9) 36(37.1)	χ²=2.17	0.03
CEA(ng/ml)	50(25, 75)	2.35(1.32, 4.28)	Z=0.77	0.44
CA125(U/ml)	2.1(1.29, 3.79)	11.19(7.81, 17.95)	Z=0.44	0.66
CA199(U/ml)	11.69(8.80, 15.91)	10.68(6.02, 20.31)	Z=0.38	0.71

项目	LDL-C<2.975 mmol/L组 (n=180)	LDL-C≥2.975 mmol/L组 (n=55)	统计值	P值
年龄(岁)	56.41±10.20	58.02±0.56	t=0.33	0.74
性别[例(%)]
男性女性	139(77.2) 41(22.8)	34(61.8) 21(38.2)	χ²=2.26	0.27
肿瘤最大径(cm)	4.00(3.00,6.00)	3.50(2.50,5.00)	Z=1.45	0.15
分化程度[例(%)]
高中分化低分化	77(42.8) 103(57.2)	31(56.4) 24(43.6)	χ²=1.77	0.08
脉管侵犯[例(%)]
是否	147(81.7) 33(18.3)	37(67.3) 18(32.7)	χ²=2.26	0.24
神经侵犯[例(%)]
是否	126(70.0) 54(30.0)	26(47.3) 29(52.7)	χ²=3.08	0.00
BMI(kg/m²)	21.65±3.21	22.51±2.80	t=2.01	0.05
pT[例(%)]
T₁-T₂ T₃-T₄	42(23.3) 138(76.7)	24(43.6) 31(56.4)	χ²=2.93	0.00
pN[例(%)]
N₀-N₁ N₂-N₃	88(48.9) 92(51.1)	40(72.7) 15(27.3)	χ²=3.10	0.00
CEA(ng/ml)	2.38(1.347, 4.82)	1.80(1.26, 3.16)	Z=2.28	0.02
CA125(U/ml)	11.60(7.92, 17.81)	10.88(8.67, 15.16)	Z=0.58	0.56
CA199(U/ml)	10.88(5.96, 20.375)	10.59(6.12, 19.15)	Z=0.15	0.88