早期胃癌患者临床病理因素与预后的关系

Relationship between clinicopathologic factors and prognosis of patients with early gastric cancer

目的探讨早期胃癌患者临床病理因素与预后之间的关系，为制定合理的治疗方案提供帮助。方法回顾性分析2002年1月至2007年10月复旦大学附属中山医院收治的459例接受D2手术的早期胃癌患者的临床资料。Kaplan—Meier法计算生存率，Log—rank检验进行单因素分析，Cox回归模型分析年龄、性别、肿瘤直径、大体类型、分化程度、浸润深度、淋巴管浸润、淋巴结转移数目对预后的影响。结果肿瘤直径、分化程度、浸润深度、淋巴管浸润和淋巴结转移数目影响早期胃癌患者预后（X^2=8．476，6．210，4．014，14．197，55．027，P〈0．05）。是否有淋巴结转移是影响早期胃癌预后的独立危险因素，且淋巴结转移数目越多，对预后的影响越大。结论淋巴结转移是影响早期胃癌预后最为重要的因素，适度地施行淋巴结清扫有重要的意义，对于存在淋巴结转移高危因素的患者更应谨慎地施行微创手术。

Objective To investigate the relationship between various clinicopathologic factors and prognosis of early gastric cancer. Methods The clinical data of 459 patients with early gastric cancer who had undergone gastreetomy combined with extended （ DE ） lymphadeneetomy at Zhongshan Hospital from January 2002 to October 2007 were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, and clini- copathologie factors such as age, sex, tumor size, gross morphology, tumor differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis were analyzed using the Cox regression model. Univariate analysis was done by Log-rank test. Results Univariate analysis demonstrated that tumor size and differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis significantly affected survival in patients with early gastric cancer （X^2 = 8.476, 6. 210, 4. 014, 14. 197, 55.027, P 〈 0.05）. The status of lymph node metastasis was an independent predictor of survival in patients with early gastric cancer, and the more metastatic lymph nodes detected, the greater the influence on the prognosis. Conclusions Lymph node metastasis is the most important factor influencing the prognosis of early gastric cancer. Appropriate lymph node dissection is necessary, especially for patients with risk factors associated with lymph node metastasis.