早期胃癌淋巴结转移和临床病理特征的关系(附467例报道)

Correlation between lymph node metastasis and clinico-pathological parameters in early gastric carcinoma: a report of 467 cases

目的:探讨早期胃癌病人各临床病理因素与淋巴结转移的关系,为制定合理的治疗方案提供帮助。方法:对467例早期胃癌病人进行回顾性分析,对其年龄、性别、肿瘤大小、大体类型、分化程度、浸润深度、淋巴管癌栓与淋巴结转移的关系进行单因素和多因素分析。结果:影响早期胃癌淋巴结转移的因素主要有:肿瘤大小(最大径,≤2cm比>2cm,P<0.01)!分化程度(分化良好比分化不佳,P<0.01)!浸润深度(黏膜层比黏膜下层,P<0.01)!淋巴管癌栓(无比有,P<0.01)。Logistic回归多因素分析结果显示,肿瘤大小!分化程度、浸润深度!淋巴管癌浸润均是提示胃癌是否有淋巴结转移的独立因素。结论:早期胃癌淋巴结转移与肿瘤大小!肿瘤分化程度!浸润深度!淋巴管癌栓等因素有关。确定早期胃癌手术方案时,可参考上述因素判断淋巴结转移风险,决定是否行淋巴结清扫术。

Objective To analyze the risk factors of lymph node （LN） metastasis in early gastric cancer （EGC） undergoing radical resection. Methods A total of 467 EGC patients surgically treated were analyzed retrospectively. Seven clinicopathological parameters（age, gender, tumor size, macroscopic type, lymphatic vessels involvement, histopathological type, depth of invasion） were investigated, and their relationship to LN metastasis were studied by using chi-square test and logistic regression analysis. Results The risk factors for LN metastasis were found to be： tumor size （≤ 2 cm vs 〉2 cm, P〈0.01）, lymphatic vessels involvement（absence vs presence, P〈0.01）, histopathological type（differentiated vs undifferentiated, P〈0.01）, depth of invasion （mucosal vs submucosal, P〈0.01 ）. Multivariate logistic regression analysis also showed that tumor size, lymphatic vessels involvement, histopathological type, depth of invasion were associated significantly with LN metastasis. Conclusions LN metastasis in EGC has been proved to be mainly correlated with tumor size, lymphatic vessels involvement, histopathological type and depth of invasion of the carcinoma.