淋巴结外软组织阳性胃癌预后相关分析

Correlation analysis of gastric cancer with extranodal metastasis

目的探讨淋巴结外软组织阳性（EM）与胃癌各种临床病理因素的相关性以及其对胃癌预后的影响。方法2001年1—12月间，天津医科大学附属肿瘤医院手术治疗和经病理确诊、且随访资料完整的胃癌患者共计276例。回顾性分析这组病例的临床资料，确定EM的相关因素及与胃癌预后的关系。结果本组276例手术标本中有58例（21．0％）EM。无EM者和有EM的胃癌患者2、3、5年生存率分别为71．2％、55．4％、45．1％和24．1％、15．5％、8．0％（P=0．000）；EM与胃癌病理分类（r=0．163，P=0．008）、浸润深度（r=0．215，P=0．003）、淋巴结转移（r=0．368，P=0．000）、远处转移（r=0．375，P=0．000）、TNM分期（r=0．441，P=0．000）、肿瘤最大径相关（r=0．167，P=0．007）（P〈0．05）；多因素分析显示，EM为胃癌独立预后因素之一。结论EM与多种胃癌临床病理因素相关，是胃癌独立预后因素。

Objective To evaluate the correlations between extranodal metastasis （EM）and clinicopathologic features of gastric cancer and the relationship between EM and prognosis of gastric cancer. Methods Data of patients with histologically proven adenocarcinoma were studied retrospectively to evaluate the prognostic factors in gastric cancer by univariate and multivariate analyses of Cox regression with SPSS 13.0 software. Two hundred and seventy-six patients with primary gastric cancer undergone operation in Tianjin Cancer Hospital from Jan. 2001 to Dec. 2001 were studied and followed up until Dec. 2006 or death. Results EMs were found in 58（21.0%） of the 276 patients. The overall 2-, 3-, and 5-year survival rates of the patients without EM were 71.2%, 55.4%, and 45.1% respectively. The overall 2-, 3-, and 5-year survival rates of the patients with EM were 24.1%, 15.5%, and 8.0% respectively. Postoperative overall survival rates were significantly lower for patients with EM than those without EM（P=0.000）. EM was correlated with differentiation （r=0.163, P= 0.008）, invasive depth （r=0.215, P=0.003）, lymph node metastasis （r=0.368, P=0.000）, distant metastasis （r=0.375, P=0.000）, advanced stage（r=0.441, P=0.000）, and tumor size （r=0.167, P= 0.007）. Multivariate analysis identified EM as an independent prognostic factor. Conclusions EM is correlated with many clinicopathological features of gastric cancer. EM is an independent prognostic factor of gastric cancer.