胃癌淋巴结转移与术后生存关系

Relationship between lymph node metastasis and postoperative survival in gastric cancer

目的研究胃癌淋巴结转移与远期生存的关系．方法对５４例胃癌手术者进行了跟踪随访，４８例获得４５ａ～８５ａ随访．内容为术后化疗、生物治疗、中药治疗、气功、饮食等健康状况．并就胃癌各站淋巴结转移情况、淋巴结大小与各站转移距离、原发癌灶边缘与淋巴结之间距离、病理特性、肿瘤侵犯深度与生存的关系作了分析．结果全组的５ａ生存率为２９２％，癌灶侵犯粘膜层者为６６７％，侵犯肌层者为６１５％，侵犯浆膜层者为２６７％．癌灶侵犯浆膜层外者术后易复发，其５ａ生存率为零，第１站淋巴结有癌转移者其５ａ生存率为１９２％，第２站淋巴结有癌转移者其５ａ生存率为１５４％，第３站淋巴结有癌转移者其５ａ生存率为１２２％．转移淋巴结距癌灶＜５ｃｍ者其５ａ生存率为２４１％，达５ｃｍ～１０ｃｍ者为１５４％，＞１１ｃｍ者为零．淋巴结癌转移灶直径＜０２ｃｍ的５ａ生存率为１１０％，＞２ｃｍ者为零．肝十二指肠韧带内淋巴结有癌转移者的５ａ生存率为７５０％（３／４），而１１例胃左动脉旁淋巴结内有癌转移者其５ａ生存率为零．结论胃癌侵及浆膜层或肝门部应行扩大淋巴结清扫、可获得较好的远期生存率．侵及浆膜外或第７组淋巴结阳性者预后不佳．淋巴结转移?

AIM To study the relationship between lymph node metastasis and survival in gastric carcinoma. METHODS Fifty four patients with gastric cancer undergoing resection were followed up for 4 5 to 8 5 years. The 5 year survival rates were obtained from 48 patients after operation by August 1997, and compared with the extent, location and size of nodal metastasis. The distance from gastric cancer to lymph nodes, and grade of infiltration and the pathological feature of the tumor were also analysed. RESULTS Among the 48 patients, the actural 5 year survival rate was 29 2%. The 5 year survival was 66 7%, in patients with invasion of the mucosa, 61 5% with invasion of the muscle, 26 7% with invasion of serosa, and zero with infiltration out of serosa, with statistically significant difference. In patients with node diameter less than 0 2cm in stage Ⅰ, the actural 5 year survival was 11% and zero with diameter more than 2cm. In patients with positive lymph node metastasis distant to the tumor less than 5cm, the 5 year survival was 24 1%; 5cm-10cm, 15 4%; and greater than 11cm, zero. CONCLUSION The expanded lymph node dissection should be performed in the radical operation, when tumor infiltrated into subserosa and lymph nodes of hepatoduodenal ligaments, so as to prolong the survival of the patients. The prognosis was poor at left gastric artery or/and with infiltration out of serosa, the further distance of lymph node metastasis to the tumor, the poorer the prognosis of patient is.