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胃癌根治术后炎性反应状态延长与胃癌患者不良预后的相关性研究
作者:龚根强  杨凌玲 
单位:宝鸡市中心医院普外科  陕西 宝鸡 721008 宝鸡市中心医院消化内科  陕西 宝鸡 721008 
关键词:胃肿瘤/外科学 手术后并发症 炎症/病因学 恶性高热 白细胞增多 存活率 预后 回顾性研究 
DOI:10.13267/j.cnki.syzlzz.2019.01.011
出版年,卷(期):页码:2019,34(1):52-56
摘要:

目的 探讨胃癌患者术后炎性反应状态的延长对患者总体生存率(overall survival,OS)的影响。方法 回顾性分析行胃癌根治术的400例胃癌患者的临床资料。以术后体温 ≥ 38℃持续 ≥ 4 d或白细胞 ≥ 10×109/L持续 ≥ 7 d定义为术后炎性反应状态延长,比较炎性反应时间延长组和非延长组OS差异,并分析影响患者术后OS的独立危险因素。结果 47例(11.8%)患者处于延长高热状态,34例(8.5%)术后处于延长白细胞增多状态,其中19例(4.8%)同时表现为延长高热和延长白细胞增多状态。术后延长高热患者5年OS低于无延长高热患者(51.5% vs70.0%,P=0.011)。术后延长白细胞增多患者5年OS低于无延长白细胞增多患者(44.1% vs70.0%,P=0.001)。多因素Cox回归分析显示,术后延长高热(HR=1.78,95%CI:1.14~2.68,P=0.008)和术后延长白细胞增多(HR=2.26,95%CI:1.98~3.63,P<0.01)是胃癌患者术后OS降低的独立危险因素。结论 胃癌患者术后长时间高热和白细胞增多状态与胃癌患者的不良预后密切相关。

Objective To investigate the impact of prolonged postoperative inflammatory status after radical gastrectomy in gastric cancer patients on the overall survival (OS).Methods The clinical data of 400 gastric cancer patients who underwent radical gastrectomy were analyzed retrospectively.Postoperative body temperature over 38℃ and lasting for over 4 days,or white blood cell (WBC) counts over 10×109/L and lasting for over 7 days was defined as prolonged postoperative inflammatory status.OS were compared between patients with and without prolonged inflammatory status,and the independent risk factors for OS in patients were analyzed. Results Among all patients,47 cases (11.8%) showed prolonged hyperthermia,and 34 cases (8.5%) had prolonged leukocytosis.Among them,19 cases (4.8%) manifested both prolonged hyperthermia and leukocytosis.Noticeably,the 5-year OS of patients with prolonged hyperthermia was significantly lower than that in patients without prolonged hyperthermia (51.5% vs 70.0%,P=0.011).Similarly,the 5-year OS was significantly lower in patients with prolonged leukocytosis than patients without prolonged leukocytosis (44.1% vs 70.0%,P=0.001).Finally,multivariate Cox regression analysis indicated that prolonged hyperthermia post-operation (HR=1.78,95% CI:1.14-2.68,P=0.008) and prolonged leukocytosis (HR=2.26,95% CI:1.98-3.63,P<0.01) were both independent risk factors for decreased OS in postoperative patients with gastric cancer. Conclusion Prolonged postoperative hyperthermia and leukocytosis are associated with poor prognosis of patients with gastric cancer.

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