Abstract: Risk factors of recurrence after radical gastrectomy in elderly gastric cancer patients        LU Jun, WU Dong, ZHENG Chao-hui, et al. Department of Gastric Surgery/General Surgery, Fujian Medical University Union Hospital; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350004, China
Corresponding author：HUANG Chang-ming ,E-mail；hcmlr2002@163.com
Abstract    Objective    To compare the clinicopathological characteristics between elderly patients with gastric cancer （GC）recurrence and those without recurrence after radical gastrectomy, and to explore the risk factors of postoperative recurrence in elderly patients with gastric cancer and to construct a predictive model. Methods    The clinical data of 727 GC patients who underwent R0 gastrectomy at Department of Gastric Surgery, Fujian Medical University Union Hospital from January 2010 to December 2014 were analyzed retrospectively, which were divided into the recurrence group (214 cases, 29.4%) and the non-recurrence group (513 cases, 70.6%). The influencing factors of postoperative recurrence were further analyzed, and a prediction model was established. Results    Compared with the non-recurrence group, preoperative CA19-9, preoperative CEA, tumor size, incidence of neurovascular infiltration and postoperative pathological TNM stage were significantly increased in the recurrence group (all P<0.001). Univariable analysis showed that preoperative CA19-9, preoperative CEA, tumor differentiation degree, pathological T stage, pathological N stage, tumor size, nerve infiltration, vascular infiltration, and postoperative adjuvant chemotherapy were correlated with postoperative recurrence. Multivariate analysis revealed that preoperative CA19-9, pathological T staging and pathological N staging, postoperative adjuvant chemotherapy were independent risk factors for postoperative recurrence of elderly patients with GC. Further, a nomogram prediction model was established, and the results showed that the model had good prediction performance, with the C index of 0.781 (0.761-0.801). Conclusion    Preoperative CA19-9 and TNM stage are independent risks, while postoperative adjuvant chemotherapy is the protective factor for recurrence in elderly patients with GC after radical resection. The nomogram model established in the study can effectively predict postoperative recurrence and may be helpful for clinical follow-up and decision-making.

Key words: gastric cancer, elderly, recurrence, risk factor, prediction model

摘要： 目的    比较老年病人行胃癌根治术后复发与无复发病人之间的临床病理特征差异，探讨老年胃癌病人术后复发的危险因素并构建预测模型。方法    回顾性分析2010年1月至2014年12月福建医科大学附属协和医院胃外科收治并施行手术的727例老年胃癌病人资料，分为复发组（214例，29.4%）与无复发组（513例，70.6%）。进一步分析术后复发的影响因素，筛选并建立拟合度最优的多因素预测模型。结果    与无复发组相比，复发组病人术前CA19-9、术前癌胚抗原（CEA）、肿瘤大小、神经脉管浸润发生率以及术后病理学TNM分期均显著增高（P均＜0.001）。单因素分析显示，术前CA19-9、术前CEA、肿瘤分化程度、病理学分期、肿瘤大小、神经浸润、脉管浸润，以及术后辅助化疗与术后复发相关；多因素分析显示，术前CA19-9、病理T分期、N分期和术后辅助化疗为独立影响因素。进一步建立列线图预测模型结果显示，该模型具有良好的预测效能，C指数为0.781（0.761-0.801）。结论    术前CA19-9和肿瘤病理学分期是老年胃癌病人根治术后复发的独立危险因素，而术后辅助化疗是其独立保护因素。建立列线图预测模型能有效预测其术后复发，可能有助于临床随访和决策。

关键词: 胃癌, 老年, 复发, 危险因素, 预测模型