| Objective:To analyze clinicopathological characteristics and prognostic factors of 102 patients diagnosed with gastric stump cancer(GSC)and treated in our hospital,and to improve understanding of this disease,achieve early detection,improve the radical resection rate and thus maximize the prognosis of GSC.Methods:Complete clinical data of 102 patients with GSC,admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2006 to July 2018,was analyzed by retrospective analysis.Among them,41 cases were benign and 61 cases were malignant.Their age ranged from 35 to 78,with an average age of 61.9±12.2.Clinical and histopathological characteristics,treatment strategies,prognostic factors in postoperative GSC patients were compared between benign cases and malignant cases.Statistical processing:all data were processed by SPSS 23.0 statistical software.Statistical data measurement in positive distribution was expressed by((?)±s),and comparison between two groups was conducted by student`s t-test.The median data of positive distribution or the data converted to positive distribution by arithmetic was compared by ANOVA.The enumeration data was expressed by X2.The survival curve was made by kaplan-meier method and survival analysis was performed by log-rank test.Cox regression model was used for multivariate analysis.The interim analysis level was set as=0.05,and difference was statistically significant when P<0.05.Results:Among the patients with GSC,47(46.1%)had first symptoms of abdominal pain and abdominal distension,19(18.6%)had dysphagia,19(18.6%)had hematemesis,and 17(12.7%)had atypical symptoms.Among them,81 cases were Han nationality and 21 cases were Uygur nationality,the ratio between whom was 4:1.Tumor was located at the anastomotic site in 67 cases and non-anastomotic site in 35 cases,with a ratio of 2:1.Histologically,50 cases were differentiated(including highly differentiated and moderately differentiated adenocarcinoma)and52 cases were undifferentiated(low-differentiated,undifferentiated,mucinous adenoc arcinoma and sigmoid-ring cell carcinoma).Primary digestive tract reconstruction was performed in 41 cases of Bi-I,51 cases of Bi-II,and 10 cases of R-Y.The proportion of male patients in postoperative GSC for benign diseases was significantly higher 97.5%(40/41)than that in postoperative GSC for malignant diseases 85.2%(52/61),=4.21,P=0.047].The time point of postoperative GSC in benign cases was also longer[(26.4 12.4)than that in malignant cases(10.3 10.3),t=-7.13,P=0.000].Primary surgery for GSC was more often in Bi-II[60.9%(25/41)than that in Bi-I 42.6%(26/61),=8.40,P=0.015].67 patients received surgical treatment,46(68.6%)radical resection,and 21(31.3%)palliative surgery.The remaining 35 patients received conservative treatment due to extensive tumor metastasis or other causes.Postoperative complications occurred in 7 patients(10.4%),including postoperative pulmonary infection in three cases,anastomotic fistula in two cases,incision infection in one case and intestinal obstruction in one case.The tumor diameter was no more than 5 cm in 36 cases,and more than 5 cm in 31 cases.Among them,27 cases were in stage I-II and 40 cases were in stage III-IV.65 patients were followed up for 2-75 months,with a median follow-up time of 32 months.The univariate prognostic analysis showed that patients with differentiated histological type,shallow invasion depth,no lymph node metastasis,no distant metastasis,early TNM stage and no postoperative complications had better prognosis(all P<0.05).The median survival time for 44 patients received radical surgery was 42 months,and the overall survival rate of 1,3 and 5 years was 84.5%,65.3%and 17.2%.21 patients received palliative surgery died within 3-15 months and the 1,3 and 5 year survival rate was 81.5%,61.4%and 41.2%respectively.1,3,5 years survival rate for T3-T4 GSC patients was 65.8%,37.7%and 9.4%.1,3 and 5 year survival rate for TNM stage I-II GSC patients was 88.5%,74.0%and 38.1%.1,3 and 5 year survival rate for TNM stage III-IV was 61.5%,33.3%and 0.0%.1,3 and 5 surviv al rate for GSC patients received surgical treatment due to benign diseases was 82.6%,61.2%and 20.2%,while that was 63.9%,46.2%and 7.7%in malignant cases,and there was no statistically significant difference between two groups(P=0.067).Cox proportional risk model analysis showed that radical surgery(HR=0.040,95%CI:0.006-0.248),TNM stage(HR=5.011,95%CI:2.010-12.492)and tumor infiltration depth(HR=0.453,95%CI:0.097-2.120)were independent risk factors affecting patients prognosis in GSC.Conclusion:Patients with GSC have atypical clinical symptoms.Postoperative male patients with GSC in benign cases are higher than those in malignant cases,which is more common after BI-II anastomosis and the time point of GSC is obviously longer.Strengthening endoscopic reexamination to patients after gastric surgery can improve the early diagnosis rate of patients with GSC,further improve its radical resection rate and long-term survival rate of GSC patients to the maximum extent. |
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