淋巴结转移率评估T_3期胃癌病人预后的价值

The value of metastatic lymph nodes ratio in predicting the prognosis of patients with T_3 gastric carcinoma

目的探讨淋巴结转移率(MLR)预测T3期胃癌病人术后生存时间的价值。方法回顾性研究89例接受根治性手术(≥D2)的T3期胃癌病人,Spearman相关性分析研究MLR及阳性淋巴结个数是否与病检淋巴结总数(≥15个)具有相关性,单因素Kaplan-Meier生存分析和多因素Cox比例风险回归分析研究MLR对术后生存时间的影响,ROC曲线判定MLR预测T3期胃癌病人术后2年内死亡的准确性,并与阳性淋巴结个数比较。结果(1)MLR高低与病检淋巴结总数无相关性(r=-0·0022,P>0·05),而阳性淋巴结个数与病检淋巴结总数则具有相关性(r=0·2504,P<0·05)。(2)Kaplan-Meier生存分析发现MLR影响术后生存时间(Log-rankχ2=35·7470,P<0·01),Cox比例风险回归分析提示MLR越高,病人死亡风险性越大(χ2=7·9708,P<0·01)。(3)MLR预测病人术后2年内死亡的ROC曲线下面积与阳性淋巴结个数的差异不具统计学意义。结论病检淋巴结≥15个时,T3期胃癌MLR高低与病检淋巴结总数不相关,在清扫范围足够的情况下,MLR预测T3期胃癌病人术后2年内死亡的准确性与阳性淋巴结个数相当,但并不优于后者。

Objective To evaluate the value of the metastatic lymph node ratio (MLR) in predicting the postoperatively survival time of patients with T3 gastric carcinoma. Methods Eighty-nine patients with T3 gastric carcinoma who underwent curative gastrectomy were analyzed retrospectively.The correlations between MLR, positive nodes and the total lymph nodes (15 or more) in histologic examination were analyzed using Spearman′s correlation analysis.The influence of MLR and positive nodes on survival time of patients was identified with univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis.The predicting accuracy of MLR to death of patients within 2 years postoperatively was determined by receiver working characteristic curve and was compared with that of positive nodes. Results (1) The MLR did not correlate with the total lymph nodes in histologic examination (Spearman′s correlation coefficient was -0.0022, P>0.05), whereas positive lymph nodes did (correlation coefficient was 0.2504, P<0.05).(2) Kaplan-Meier survival analysis identified that the MLR influenced significantly the survival time postoperatively (Log-rank χ2=35.7470, P<0.01).Cox proportional hazard model showed the high MLR was an independent poor prognostic factor (χ2=7.9708, P<0.01).(3) There was not difference between the area under the receiver working curve of MLR and positive nodes to predict the death of patients within 2 years postoperatively (P>0.05). Conclusion The MLR in T3 gastric carcinoma is not correlated with the number of total lymph nodes examined on the condition that 15 or more lymph nodes were assessed in pathology.The predicting accuracy of MLR to death of patients with T3 gastric carcinoma within 2 years postoperatively is same as, but not better than that of positive nodes if the extent of lymphadenectomy is optimal.