2025 年第 5 期 第 20 卷

影响局部进展期胃癌新辅助化疗病理反应的因素分析

Analysis of the influencing factors of pathological response to neoadjuvant chemotherapy in locally advanced gastric cancer

作者：马得原1王锐1张凤竹1韩晶1曾苗苗2关泉林1,2

英文作者：Ma Deyuan1 Wang Rui1 Zhang Fengzhu1 Han Jing1 Zeng Miaomiao2 Guan Quanlin12

单位：1兰州大学第一临床医学院，兰州730000；2兰州大学第一医院胃肠肿瘤外科，兰州730000

英文单位：1The First Clinical Medical College of Lanzhou University Lanzhou 730000 China; 2Department of Gastrointestinal Surgical Oncology First Hospital of Lanzhou University Lanzhou 730000 China

关键词：局部进展期胃癌；新辅助化疗；病理反应

英文关键词：Locallyadvancedgastriccancer;Neoadjuvantchemotherapy;Pathologicalresponse

• 摘要：

• 目的 探讨局部进展期胃癌（LAGC）患者在接受新辅助化疗（NACT）过程中，影响患者病理反应的因素。方法 连续性收集2014年1月至2020年12月在兰州大学第一医院就诊的216例接受NACT联合根治性胃切除术的LAGC患者的临床资料进行回顾性分析，根据肿瘤退缩分级（TRG）分为病理反应良好组（TRG 0/1,38例）和病理反应不良组（TRG 2/3,178例）。采用Logistic回归分析方法评估影响因素，使用受试者工作特征（ROC）曲线分析独立影响因素的预测效能。结果 与病理反应不良组相比，病理反应良好组具有组织学分化良好（P=0.014）、Borrmann分型Ⅱ型比例高（P=0.003）、T分期早（P=0.003）、Δ肿瘤标志物阳性个数多（P=0.005）和Ki-67低（P＜0.001）的特点。Logistic回归分析结果显示组织学分化程度高（P=0.007）、T分期早（P=0.034）、Δ肿瘤标志物阳性个数多（P=0.002）和Ki-67低（P＜0.001）是病理反应良好的独立影响因素。ROC曲线分析结果显示上述指标综合预测病理反应良好的曲线下面积为0.875（95%置信区间：0.805～0.945，P＜0.001）。结论 组织学分化良好、Borrmann分型Ⅱ型、T分期早、Δ肿瘤标志物阳性个数多和Ki-67低是LAGC患者在NACT后出现良好病理反应的影响因素，其中组织学分化良好、T分期早、Δ肿瘤标志物阳性个数多和Ki-67低是独立影响因素，各指标综合具有良好的预测价值。

• Objective To investigate the influencing factors of pathological response in patients with locally advanced gastric cancer (LAGC) receiving neoadjuvant chemotherapy (NACT). Methods The clinical data of 216 LAGC patients who underwent NACT combined with radical gastrectomy in the First Hospital of Lanzhou University from January 2014 to December 2020 were collected and retrospectively analyzed. According to tumor regression grade (TRG), the patients were divided into good pathological response group(TRG 0/1, 38 cases) and poor pathological response group(TRG 2/3, 178 cases). Logistic regression analysis was used to evaluate the influencing factors, and receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of independent influencing factors. Results Compared with the poor pathological response group, the good pathological response group was characterized by good histological differentiation(P=0.014), higher proportion Borrmann type Ⅱ(P=0.003), earlier T stage(P=0.003), more Δ number of positive tumor markers(P=0.005) and lower Ki-67 (P＜0.001). Logistic regression analysis showed that high histological differentiation (P=0.007), early T stage (P=0.034), more Δ number of positive tumor markers (P=0.002) and low Ki-67 (P＜0.001) were independent factors for good pathological response. ROC curve analysis showed that the area under the curve of the above indicators to predict good pathological response was 0.875 (95% confidence interval: 0.805-0.945)(P＜0.001). Conclusions  The good histological differentiation, Borrmann type Ⅱ, early T stage, more Δ number of tumor markers and low Ki-67 were the influencing factors of good pathological response in LAGC patients after NACT. The good histological differentiation, early T stage, more Δ number of tumor markers and low Ki-67 were independent influencing factors. The combination of each index had good predictive value.