胃癌淋巴结转移规律的探讨

An investigation on the lymph node metastasis in gastric carcinoma

目的探讨胃癌淋巴结转移的规律。方法回顾我院1994年1月至2003年5月间608例胃癌术后病理资料,分析各组淋巴结的转移率,并用二值Logistic回归似然比法分析与第7～9组淋巴结转移相关的因素。结果本组608例中,第3组淋巴结转移率最高,为444%,其次为第15组的432%。第7、8、9组淋巴结转移率分别为372%、248%和207%,3组综合转移率为375%。与第7～9组淋巴结综合转移密切相关的因素有第1～6组淋巴结综合转移情况和肿瘤的浸润程度(P<005)。第7～9组淋巴结有转移时,预测第1～6组淋巴结有转移的准确率为822%,假阳性率为15%;第7～9组淋巴结无转移时,预测第10～16组淋巴结无转移的准确率为593%,假阳性率为127%。结论第7～9组淋巴结有类似前哨淋巴结的作用,术中病理活检有利于指导胃癌术式的选择。胃下部癌第7～9淋巴结有转移时宜常规清扫第15组淋巴结。

Objective To investigate the lymph node metastases in gastric carcinoma and its clinical significance Methods The clinicopathological data of 608 patients with gastric carcinoma were analyzed retrospectively The total metastatic rate was calculated Binary logistic regression analysis was used to analyze the influence index of ten clinicopathological factors on the No 7～9 lymph node metastases Results The metastases rate (44 4%) of No 3 group lymph node was the highest seconded by No 15 group (43 2%) The overall lymph node metastases in No 7～9 group was 37 5% The depth of tumor invasion and the lymph node metastases in No 1～6 group were significantly correlated with lymph node metastases in the No 7～9 group ( P < 0 05) When lymph node metastasis is diagnosed in No 7～9 by biopsy during operation, the incidence rate of lymph nodes metastasis in No 1～6 is 82 2% with a false positive rate of 15% ( χ 2=18 6, P = 0 000?1 ) While none lymph node metastasis in No 7～9 by biopsy during operation , the incidence rate of none lymph nodes metastasis in No 10～16 is 59 3% with an false positive rate of 12 7% ( χ 2=25 9, P =0 000?1). Conclusions The status of lymph node in No 7～9 groups acts as a sentinel indicating the necessity of further lymph node dissection No 15 group lymphadenectomy should be performed in cases of lower gastric carcinoma when No 7～9 group lymph node metastasis is identified