早期胃癌淋巴结转移规律的探讨

A study on lymph node metastasis in early gastric carcinoma

目的研究早期胃癌淋巴结转移的规律。方法对青岛大学医学院附属医院2001年7月至2007年7月期间手术治疗的177例早期胃癌的临床病例资料进行Logistic回归分析。结果本组177例早期胃癌的淋巴结转移率为13％，第一站（N1）和第二站（N2）的转移率分别为13％和3％。单因素分析发现，黏膜内癌和黏膜下癌的淋巴结转移率分别为3％（3／88）和22％（20／89）（χ^2=14．222，P〈0．01）；肿瘤长径小于2cm和2cm以上的胃癌的淋巴结转移率分别为3％（4／117）和32％（19／60）（χ^2=27．992，P〈0．01）；分化型胃癌与未分化型胃癌的淋巴结转移率分别为4％（3／81）和21％（20／96）（χ^2=11．402，P=0．001）；大体分型Ⅰ型、Ⅱ型和Ⅲ型淋巴结转移率分别为33％（2／6）、8％（7／99）和19％（14／92）（χ^2=8．172，P=0．014）。Logistic回归分析提示，肿瘤长径大于2cm（OR=8．408，P〈0．01）、侵及黏膜下层（OR=5．926，P=0．009）和未分化型胃癌（OR=4．880，P=0．020）为早期胃癌淋巴结转移的独立危险因素。结论早期胃癌淋巴结转移与肿瘤浸润深度、肿瘤长径和肿瘤分化程度有关。

Objective To study lymph node metastasis in early gastric carcinoma. Methods From July 2001 to July 2007, 177 patients with early gastric carcinoma underwent radical gastrectomy and the clinicopathologic data were analyzed by binary logistic regression. Results The overall rate of lymph node metastasis in early gastric carcinoma was 13%, involving 13% and 3% in level Ⅰ （ N1 ） and level Ⅱ lymph nodes （ N2 ）, respectively. The rate of lymph node metastasis was 22% （ 20/89 ） in cases of submucosal lesion （SM）, which was significantly higher than 3% （3/88）in cases of mucosal lesion （M） （ χ^2 = 14. 222 ,P 〈 0.01 ）. The rate of lymph node metastasis was 3% （4/117 ） when the primary tumor was ≤2 cm in diameter compared with 32% （19/60） when the tumor was 〉 2 cm （ χ^2 = 27. 992,P 〈 0.01 ）. The lymph node metastasis rate was 4% （3/81 ）and 21% （20/96）in differentiated and undifferentiated lesion （ χ^2= 11. 402, P = 0. 001 ）, and it was 33 % （ 2/6）, 8% （ 7/99 ） and 19% （14/92） in macroscopic type Ⅰ , Ⅱ and Ⅲ （χ^2= 8. 172 ,P =0. 014）. Binary logistic analysis found that the tumour diameter greater than 2. 0 cm （ OR = 8.408, P 〈 0. 01 ）, infiltration of the submucosal layer（ OR = 5. 926, P = 0. 009） and undifferentiated lesion（ OR = 4. 880,P = 0. 020）were the independent risk factors. Conclusion Lymph node metastasis in early gastric carcinoma is significantly cantingent on the depth of infiltration, tumor size and histological type.