淋巴结转移率对T2～T3期胃癌患者预后评估的价值

Prognostic significance of metastatic lymph nodes ratio in patients with T2-T3 stage gastric cancer

目的探讨淋巴结转移率在T2～T3期胃癌患者预后评估中的临床应用价值。方法回顾238例接受胃癌D2根治术治疗且清扫的淋巴结总数大于或等于15枚的T2-T3期胃癌患者的临床资料，分析研究淋巴结转移率及淋巴结转移阳性枚数是否与检出的淋巴结总数具有相关性和淋巴结转移率等病理因素对胃癌预后的影响，判定淋巴结转移率预测T2～T3期胃癌患者术后5年死亡与否的准确性，并与淋巴结转移阳性个数的预测结果比较。结果淋巴结转移率与检出的淋巴结总数无相关性，而淋巴结转移阳性枚数与检出的淋巴结总数则具有相关性。单因素Kaplan-Meier法生存分析提示，淋巴结转移率与患者预后密切相关；多因素Cox比例风险回归模型分析提示，淋巴结转移率是T2～T3期胃癌患者预后主要的独立危险因素；淋巴结转移率预测T2—T3期胃癌患者术后5年死亡与否的ROC曲线下面积与淋巴结转移阳性枚数的差异无统计学意义。结论清扫的淋巴结总数大于或等于15枚时。T2～T3期胃癌患者淋巴结转移率高低与清扫的淋巴结总数不相关；淋巴结转移率是T2～T3期胃癌患者预后主要独立性危险因素；淋巴结转移率预测T2～T3期胃癌患者术后5年死亡与否的准确性与淋巴结转移阳性枚数的预测能力相同。

Objective To evaluate the prognostic significance of metastatic lymph nodes ratio in patients with T2-T3 stage gastric cancer. Methods Clinical data of 238 patients with T2-T3 stage gastric cancer undergone radical gastrectomy and D2 lymphadenectomy, at least 15 lymph nodes was dissected per patient, were analyzed retrospectively. Spearman correlation analysis was used to determine the correlation coefficient. Survival was determined by the Kaplan-Meier method and differences were assessed by the Log-rank test. Multivariate analysis was performed using the Cox proportional hazard regression model in forward stepwise regression. Receiver working characteristic curve was used to compare the accuracy of the metastatic lymph nodes ratio in predicting the death of patients 5 years postoperatively and that of metastatic lymph nodes number. Results The metastatic lymph nodes ratio didn＇t correlate with the total number of dissected lymph nodes, whereas metastatic lymph nodes number did. Kaplan-Meier survival analysis demonstrated the metastatic lymph nodes ratio significantly influenced the postoperative survival time and Cox proportional hazard regression model analysis showed the metastatic lymph nodes ratio was an independent poor prognostic factor. There was no significant difference between the area under the receiver working characteristic curve of metastatic lymph nodes ratio and metastatic lymph nodes number in predicting the death of patients 5 years postoperatively. Conclusions The metastatic lymph nodes ratio in T2-T3 stage gastric cancer patients is not correlated with the total number of dissected lymph nodes if at least 15 lymph nodes are dissected. The metastatic lymph nodes ratio is a major independent poor prognostic factor of the patients of T2-T3 stage gastric cancer. The ability of the metastatic lymph nodes ratio in predicting the death of T2-T3 stage gastric cancer patients 5 years postoperatively is the same as that of metastatic lymph nodes number.