淋巴结转移阴性的胃癌患者临床病理特征及生存分析

Clinicopathologic features of the patients with node- negative metastasis gastric adenocarcinoma and their survival analysis

目的探讨常规病理检查淋巴结转移阴性(pN0)胃癌患者的预后。方法回顾性分析87例pN0胃癌患者的临床病理特征与生存率的关系。结果全组患者男性79.3%,女性20.7%;超过60岁者占44.8%。26.4%的肿瘤位于上部(U),23.0%在中部(M),51.4%位于下部(L)。肿瘤小于或等于2cm者29.9%,2～5cm者57.5%,大于或等于5cm者12.6%。D2式淋巴结清扫86.2%,D3式(包括D3+式)淋巴结清扫13.8%。远端胃切除67.8%,近端胃切除4.6%,全胃切除27.6%。57.5%的患者术中输血。23例(26.4%)患者术后接受化疗。全组患者5年生存率56.5%。是否术后化疗、不同pT分级、有无淋巴管和血管浸润患者间的生存率比较,P<0.05;差异有统计学意义。病理分级中的T分级增加是危险因子,术后化疗是保护因子。结论为提高pN0胃癌患者5年生存率,需选择合适的术后化疗。

Objective To investigate the clinicopathologic features of the patients with node-negative metastasis （pN0） gastric carcinoma confirmed by routine pathologic examination （H＆E staining）, and their relationship with survival. Methods The clinico-pathologic data of 87 pN0 gastric carcinoma patients were analyzed retrospectively. Kaplan-Meier （Log-rank） method was used to compare the survival rate, and Cox regression method was used to screen the independent prognosis factors for pN0 gastric cancer. Results There were 69 males and 18 femals.D2 lymphadenectomy was performed in 75 （86.2%） ,and D3 in 13 cases（13.8% ）. Distal gastrectomy was performed in 59（67.8% ）, total gestrectomy in 24（27.6% ） and proximal gastrectomy in 14 cases （4. 6% ） . Twenty-three（26.4% ） cases received＇ postoperative chemotherapy and 64（73.6% ） did not. The S-year survival rate of the 87 pN0 gastric carcinoma patients was 56. 5%. There were no differences in survival rate considering age, tumor location, gastrectomy, lymph nodes dissection, differentiation grade, and tumor-stroma relationship（ P 〉 0.05）, while the differences were significant in survival rate between the patients with postoperative chemotherapy, lymphatic invasion, venous invasion or not, and different pT staging （all P 〈 0.05） . The Cox regression analysis revealed that pT staging and postoperative chemotherapy were independent prognostic factors. Conclusion pT staging and postoperative chemotherapy are independent prognostic factors. It is necessary to develop a precise staging technique to select a suitable surgical therapy or confirm which patients should accept postoperative chemotherapy in pN0 gastric carcinoma patients.