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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 230 -237. doi: 10.3877/cma.j.issn.1674-0793.2026.04.003

论著

早发性可切除胃癌的临床病理特征及预后列线图模型的建立
江伟东1, 陈博2,†()   
  1. 1　236000　阜阳，安徽医科大学附属阜阳市人民医院普外科
    2　230001　合肥，安徽医科大学第一附属医院普外科
  • 收稿日期:2025-09-01 出版日期:2026-08-01
  • 通信作者: 陈博
  • 基金资助:
    国家自然科学基金青年科学基金项目(81602425)

Establishment of clinicopathological features and prognostic nomogram of early-onset resectable gastric cancer

Weidong Jiang1, Bo Chen2,†()   

  1. 1 Department of General Surgery, Fuyang People’s Hospital Affiliated to Anhui Medical University, Fuyang 236000, China
    2 Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230001, China
  • Received:2025-09-01 Published:2026-08-01
  • Corresponding author: Bo Chen
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引用本文：

江伟东, 陈博. 早发性可切除胃癌的临床病理特征及预后列线图模型的建立[J/OL]. 中华普通外科学文献(电子版), 2026, 20(04): 230-237.

Weidong Jiang, Bo Chen. Establishment of clinicopathological features and prognostic nomogram of early-onset resectable gastric cancer[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(04): 230-237.

目的

分析早发性胃癌（EOGC）患者临床病理特征及预后情况。

方法

回顾性纳入2012年1月至2018年12月间在安徽医科大学第一附属医院行手术治疗的4 712例胃癌患者，利用倾向评分匹配法分析比较EOGC及非EOGC患者的临床病理特征差异，并通过随访和生存曲线分析预后，单因素和多因素回归分析筛选EOGC患者的预后影响因素，最终建立预测EOGC患者总生存期的列线图模型。

结果

胃癌患者中EOGC患者298例，非EOGC患者4 414例。经过倾向评分匹配，229例EOGC患者（EOGC组）及458例非EOGC患者（非EOGC组）被纳入分析，两组血管侵犯和分化程度差异有统计学意义（P<0.05）。EOGC组患者中位生存期为56.06个月（1 682 d），明显短于非EOGC组的69.1个月（2 073 d）。多因素分析结果显示，年龄、肿瘤最大径、获取淋巴结数目、阳性淋巴结数目、TNM分期、卒中病史均为EOGC患者预后的影响因素（P<0.05）。依此建立的列线图模型预测1、5、8年生存期的AUC分别为0.770（95% CI：0.724~0.816）、0.791（95% CI：0.750~0.831）、0.802（95% CI：0.730~0.875），具有良好的预后预测准确性。

结论

EOGC是一种少发性疾病，其预后明显劣于非EOGC患者，应引起临床重视，建立的列线图模型能够有效预测EOGC患者的预后。

关键词: 胃肿瘤, 早发性胃癌, 临床病理特征, 列线图, 预后
Objective

To analyze the clinical features and prognosis of patients with early-onset gastric cancer (EOGC).

Methods

A retrospective study was conducted, including 4 712 patients with gastric cancer who underwent surgical treatment in the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2018. The difference in clinicopathological features between the patients with EOGC and those with non-EOGC was compared by propensity score matching. Follow-up data and survival curves were used to analyze the prognosis of patients, and the prognosis factors between the two groups was analyzed by univariate and multivariate regression analysis, ultimately establishing a nomogram model to predict overall survival in EOGC patients.

Results

There were 298 EOGC patients and 4 414 non-EOGC patients. After propensity score matching analysis, 229 patients in the EOGC group and 458 patients in the non-EOGC group were enrolled. Vascular invasion and differentiation showed significantly differences between the two groups (P<0.05). The median survival time for the EOGC group was 56.06 months (1 682 days), significantly shorter than 69.1 months (2 073 days) for the non-EOGC group. Multivariate analysis results indicated that age, maximum tumor diameter, the number of lymph nodes retrieved, the number of positive lymph node, TNM staging, and history of stroke were the prognsic factors for EOGC patients (all P<0.05). Based on the the above factors, a nomogram model was established to predict the overall survival of EOGC patients. The AUC for the nomogram model predicting 1, 5, and 8-year survival rates were 0.770 (95% CI: 0.724-0.816), 0.791 (95% CI: 0.750-0.831), 0.802 (95% CI: 0.730-0.875), respectively, showing good prognostic accuracy.

Conclusions

EOGC is a rare disease with obviously worse prognosis than that of non-EOGC patients, warranting further clinical attention. The established nomogram model can effectively predict the prognosis of EOGC patients.

Key words: Stomach neoplasms, Early-onset gastric cancer, Clinicopathological features, Nomograms, Prognosis
表1 匹配前纳入胃癌患者的一般情况
项目 总体(4 712例) EOGC组(298例) 非EOGC组(4 414例) 统计值 P值
年龄(岁)a 64.00 (56.00, 70.00) 41.00 (37.00, 44.00) 64.00 (58.00, 70.00) -28.950 -
性别 102.500 <0.001b
女 1 223 (25.96) 152 (51.01) 1 071 (24.26)
男 3 489 (74.04) 146 (48.99) 3 343 (75.74)
高血压史 -1.050 0.290
无 3 198 (67.87) 211 (70.81) 2 987 (67.67)
有 1 514 (32.13) 87 (29.19) 1 427 (32.33)
糖尿病史 -1.370 0.279
无 4 136 (87.78) 268 (89.93) 3 868 (87.63)
有 576 (12.22) 30 (10.07) 546 (12.37)
心脏病史 -0.210 0.346
无 4 319 (91.66) 278 (93.29) 4 041 (91.55)
有 393 (8.34) 20 (6.71) 373 (8.45)
卒中病史 <0.001 0.093
无 4 275 (90.73) 279 (93.62) 3 996 (90.53)
有 437 (9.27) 19 (6.38) 418 (9.47)
手术史 0.229 0.972
无 4 469 (94.84) 282 (94.63) 4 187 (94.86)
有 243 (5.16) 16 (5.37) 227 (5.14)
胃癌家族史 0.232 0.431
无 4552 (96.60) 285 (95.64) 4267 (96.67)
有 160 (3.40) 13 (4.36) 147 (3.33)
体重指数(kg/m2)a 20.55 (18.96, 22.25) 20.72 (18.98, 22.98) 20.54 (18.96, 22.20) -1.328 0.184
肿瘤最大径(cm)a 4.00 (3.00, 6.00) 4.00 (2.50, 6.00) 4.00 (3.00, 6.00) -1.054 0.292
获取淋巴结数目(个)a 20.00 (15.00, 27.00) 19.00 (14.00, 29.00) 20.00 (15.00, 27.00) 1.874 0.171
阳性淋巴结数目(个)a 1.00 (0, 6.00) 1.00 (0, 7.00) 1.00 (0, 6.00) 0.206 0.837
pT分期 4.180 0.017b
T1 749 (16.64) 61 (22.76) 688 (16.26)
T2 317 (7.04) 15 (5.60) 302 (7.14)
T3 381 (8.47) 15 (5.60) 366 (8.65)
T4 3 053 (67.84) 177 (66.04) 2 876 (67.96)
pN分期 2.110 0.065
N0 1 639 (36.42) 93 (34.70) 1 546 (36.53)
N1 743 (16.51) 37 (13.81) 706 (16.68)
N2 850 (18.89) 44 (16.42) 806 (19.05)
N3 1 268 (28.18) 94 (35.07) 1 174 (27.74)
pM分期 <0.001 1.000
M0 4 471 (99.36) 267 (99.63) 4 204 (99.34)
M1 29 (0.64) 1 (0.37) 28 (0.66)
pTNM分期 0.891 0.396
Ⅰ 1 084 (24.09) 67 (25.00) 1 017 (24.03)
Ⅱ 1 441 (32.02) 74 (27.61) 1 367 (32.30)
Ⅲ 1 946 (43.24) 126 (47.01) 1 820 (43.01)
Ⅳ 29 (0.64) 1 (0.37) 28 (0.66)
分化程度 102.500 <0.001b
低 1 722 (41.98) 184 (73.90) 1 538 (39.92)
中-高 2 380 (58.02) 65 (26.10) 2 315 (60.08)
腺癌 3.382 0.066
否 690 (14.64) 55 (18.46) 635 (14.39)
是 4 022 (85.36) 243 (81.54) 3 779 (85.61)
血管侵犯 1.446 0.229
无 3 666 (77.80) 223 (74.83) 3 443 (78.00)
有 1 046 (22.20) 75 (25.17) 971 (22.00)
神经侵犯 1.874 0.171
无 4 468 (94.82) 277 (92.95) 4 191 (94.95)
有 244 (5.18) 21 (7.05) 223 (5.05)
术后化疗 21.000 <0.001b
无 1 574 (33.40) 42 (14.09) 1 532 (34.71)
有 3 138 (66.60) 256 (85.91) 2 882 (65.29)
手术方式 39.100 <0.001b
全胃切除 2 840 (60.27) 151 (50.67) 2 689 (60.92)
近端胃切除 314 (6.66) 23 (7.72) 291 (6.59)
远端胃切除 1 558 (33.07) 124 (41.61) 1 434 (32.49)
表2 匹配后纳入胃癌患者的一般情况
项目 总体(687例) EOGC组(229例) 非EOGC组(458例) 统计值 P值
年龄(岁)a 58.00 (44.00, 66.00) 42.00 (37.00, 44.00) 64.00 (58.00, 70.00) - -
性别 <0.001 1.000
女 339 (49.30) 113 (49.30) 226 (49.30)
男 348 (50.70) 116 (50.70) 232 (50.70)
高血压史 0.021 0.884
无 476 (69.30) 160 (69.90) 316 (69.00)
有 211 (30.70) 69 (30.10) 142 (31.00)
糖尿病史 <0.001 1.000
无 633 (92.10) 211 (92.10) 422 (92.10)
有 54 (7.86) 18 (7.86) 36 (7.86)
心脏病史 <0.001 1.000
无 645 (93.90) 215 (93.90) 430 (93.89)
有 42 (6.11) 14 (6.11) 28 (6.11)
卒中病史 <0.001 1.000
无 646 (94.00) 215 (93.90) 431 (94.10)
有 41 (5.97) 14 (6.11) 27 (5.90)
手术史 <0.001 1.000
无 657 (95.60) 219 (95.60) 438 (95.63)
有 30 (4.37) 10 (4.37) 20 (4.37)
胃癌家族史 3.144 0.076
无 669 (97.40) 219 (95.60) 450 (98.25)
有 18 (2.62) 10 (4.37) 8 (1.75)
体重指数(kg/m2)a 20.5 (18.80, 22.30) 20.7 (18.80, 22.80) 20.4 (18.80, 22.10) -1.103 0.270
肿瘤最大径(cm)a 4.50 (3.00, 6.10) 4.00 (3.00, 6.00) 5.00 (3.00, 6.50) -1.880 0.060
获取淋巴结数目(个)a 21.0 (15.00, 29.0) 21.0 (15.00, 30.00) 21.0 (15.0, 28.0) -0.197 0.844
阳性淋巴结数目(个)a 2.00 (0.00, 7.00) 3.00 (0.00, 8.00) 2.00 (0.00, 7.00) -0.520 0.603
pT分期 -0.992 0.120
T1 107 (15.60) 45 (19.70) 62 (13.50)
T2 48 (6.99) 15 (6.55) 33 (7.21)
T3 50 (7.28) 12 (5.24) 38 (8.30)
T4 482 (70.20) 157 (68.60) 325 (71.00)
pN分期 -1.002 0.179
N0 209 (30.40) 74 (32.30) 135 (29.50)
N1 113 (16.40) 32 (14.00) 81 (17.70)
N2 142 (20.70) 40 (17.50) 102 (22.30)
N3 223 (32.50) 83 (36.20) 140 (30.60)
pM分期 <0.001 1.000
M0 684 (99.60) 228 (99.60) 456 (99.60)
M1 3 (0.44) 1 (0.44) 2 (0.44)
pTNM分期 <0.001 1.000
Ⅰ 149 (21.70) 50 (21.80) 99 (21.60)
Ⅱ 199 (29.00) 66 (28.80) 133 (29.00)
Ⅲ 336 (48.90) 112 (48.90) 224 (48.90)
Ⅳ 3 (0.44) 1 (0.44) 2 (0.44)
分化程度 47.520 <0.001b
低 366 (53.30) 165 (72.10) 201 (43.90)
中-高 321 (46.70) 64 (27.90) 257 (56.10)
腺癌 0.006 0.939
否 22 (3.20) 8 (3.49) 14 (3.06)
是 665 (96.80) 221 (96.50) 444 (96.90)
血管侵犯 4.868 0.027b
无 514 (74.80) 159 (69.40) 355 (77.50)
有 173 (25.20) 70 (30.60) 103 (22.50)
神经侵犯 0.877 0.349
无 643 (93.60) 211 (92.10) 432 (94.30)
有 44 (6.40) 18 (7.86) 26 (5.68)
术后化疗 0.446 0.582
无 113(16.45) 35(15.28) 78(17.03)
有 574(83.55) 194(84.72) 380(82.97)
手术方式 0.965 0.077
全胃切除 352(51.23) 119(51.96) 233(48.69)
近端胃切除 32(4.66) 11(4.80) 21(4.59)
远端胃切除 303(44.11) 99(43.24) 204(46.72)
图1 早发性胃癌患者的典型病理图像（免疫组织化学染色 ×200）A. 中-高分化腺癌；B. 低分化腺癌；C~D. 腺癌伴脉管侵犯
图2 未匹配前早发性胃癌（EOGC）及非EOGC患者的总生存期比较
图3 倾向评分匹配后早发性胃癌（EOGC）及非EOGC患者的总生存期比较
表3 早发性胃癌患者预后影响因素的单因素分析
因素 HR Z值 P值 95% CI
年龄 1.014 3.183 0.001a 1.005~1.022
体重指数 1.038 1.661 0.097 0.993~1.085
肿瘤最大径 1.139 11.068 <0.001a 1.113~1.166
获取淋巴结数目 1.032 7.154 <0.001a 1.023~1.041
阳性淋巴结数目 1.077 11.195 <0.001a 1.063~1.091
TNM分期 3.501 10.109 <0.001a 2.746~4.464
男性 1.143 1.185 0.236 0.916~1.426
高血压史 1.042 0.337 0.736 0.822~1.320
糖尿病史 1.000 0.001 0.999 0.660~1.517
心脏病史 1.407 1.639 0.101 0.935~2.117
卒中病史 1.860 3.131 0.002a 1.261~2.742
手术史 1.446 1.518 0.129 0.898~2.326
胃癌家族史 1.367 1.018 0.309 0.749~2.494
分化程度 0.702 -3.093 0.002a 0.561~0.878
腺癌 0.974 -0.081 0.936 0.519~1.829
血管侵犯 1.472 3.147 0.002a 1.157~1.872
神经侵犯 1.819 3.162 0.002a 1.255~2.636
术后化疗 1.025 1.556 0.061 0.740~2.411
手术方式 1.009 1.438 0.072 0.598~2.333
表4 早发性胃癌患者预后影响因素的多因素分析
因素 HR Z值 P值 95% CI
年龄 1.018 3.997 <0.001a 1.009~1.027
肿瘤最大径 1.094 5.785 <0.001a 1.061~1.128
获取淋巴结数目 0.981 -2.208 0.027a 0.964~0.998
阳性淋巴结数目 1.068 4.002 <0.001a 1.034~1.103
TNM分期 2.161 5.015 <0.001a 1.599~2.921
卒中病史 1.652 2.502 0.012a 1.115~2.447
分化程度 0.763 -2.25 0.024a 0.602~0.966
血管侵犯 0.938 -0.485 0.628 0.726~1.213
神经侵犯 1.401 1.686 0.092 0.947~2.072
图4 早发性可切除胃癌患者预后列线图的建立
图5 列线图模型预测早发性可切除胃癌患者1、5、8年生存期的受试者工作特征曲线曲线下面积（AUC）
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