进展期胃癌腹主动脉旁淋巴结转移的相关因素及其对预后的影响

Influencing factors and prognostic impact of para-aortic lymph nodes metastasis in advanced gastric cancer

目的分析进展期胃癌腹主动脉旁淋巴结(No.16组淋巴结)转移的相关临床病理因素及其对预后的影响。方法接受根治性腹主动脉旁淋巴结清扫的进展期胃癌95例,依No.16组淋巴结转移状况分为阴性组(n=64)、阳性组(n=31),分析No.16组淋巴结转移的相关临床病理因素及其对预后影响。结果 Logistic回归分析表明,性别、年龄、肿瘤部位、大小、远处转移率、Borrmann分型、WHO分型、分化程度、CEA与No.16组淋巴结转移无显著相关性(均P>0.05)。No.16阳性组与阴性组中,累及邻近脏器(T4)者分别占54.8%、32.8%,淋巴结转移度>40%者分别占74.2%、14.1%,TNMⅣ期者分别占83.9%、43.8%,肿瘤临近脏器浸润(T4)、临床分期Ⅳ期、淋巴结转移度>40%与No.16组淋巴结转移相关。No.16组淋巴结转移阴性和阳性患者的中位生存期分别为45.5、9.7个月,阳性组预后显著不良(P<0.05)。生存分析显示肿瘤部位、分化程度、淋巴结转移度、远处转移、No.16组淋巴结转移、TNM分期影响患者预后。COX回归分析显示No.16组淋巴结转移、分化程度为独立预后因素。分层分析表明,无脏器侵犯、合并脏器侵犯、淋巴结转移度1%～40%、无远处转移时,No.16阳性组的预后均显著不良(均P<0.05)。淋巴结转移度41%～100%、合并远处转移时,两组的预后相比,差异无统计学意义(P>0.05)。No.16组淋巴结阳性、远处转移、No.16组淋巴结并远处转移患者之间的预后比较差异无统计学意义(P>0.05)。结论对接受根治性No.16组淋巴结清扫的胃癌患者,邻近脏器浸润、淋巴结转移度>40%为No.16组淋巴结转移的主要相关因素,No.16组淋巴结转移患者的预后与远处转移者相当。

Objective To analyze the influencing factors and prognostic impact of para-aortic lymph nodes metastasis (PALN) in gastric cancer. Methods From January 1997 to January 2010 , 95 cases with advanced gastric cancer underwent D2 or D2+ radical resection plus PALN dissection in Gastric Cancer Center of Sun Yat-sen University. All cases were divided into No.16 positive group (n=31) and negative group (n=64). The influencing factors of PALN metastasis were analyzed , and prognosis of the two groups was compared. Results Gender, age, tumor location, tumor size, distal metastasis, Borrmann type, WHO type, differentiation degree , and CEA value were not correlated with PALN metastasis (P>0.05). The percentages of the patients with T 4 invasion, lymph node metastasis ratio more than 40% , TNM Ⅳ stage, in PALN positive and negative groups were respectively 54.8% and 32.8% , 74.2% and 14.1%, 83.9% and 43.8% (all P<0.05). Multivariate analysis showed the major influencing factors of PALN metastasis included adjacent organs invasion (P =0.033) and lymph nodes metastasis ratio more than 40% (P=0.000). The median survival time of the No.16 positive and negative groups were 45.5 and 9.7 months (P <0.05). Survival analysis revealed that tumor location , differentiationdegree, lymph node metastasis ratio , distant metastasis, PALN metastasis, TNM stage were significantly associated with prognosis ,while only PALN metastasis and differentiation degree were independent prognostic factors. There were no significant differences in survival among the patients with PALN or distant metastasis and both of them. Conclusions In advanced gastric cancer, adjacent organ invasion and LN metastasis ratio more than 40% were the major influencing factors of PALN metastasis. PALN metastasis and differentiation degree are independent prognostic factors. The prognosis in cases with positive PALN was similar to that with distal metastasis.