孤立性淋巴结转移对胃癌预后的影响

Impact of solitary lymph node metastasis on the prognosis of gastric cancer

目的探讨胃癌发生孤立性淋巴结转移对患者预后的影响。方法总结1995年1月至2003年12月间施行胃癌D2根治术的280例患者的临床资料．比较分析有淋巴结孤立性转移（孤立转移组）与无淋巴结转移（无转移组）两组患者的预后差异，进一步比较孤立转移组中跳跃性与非跳跃性淋巴结转移患者预后的差异：并进行预后因素分析。结果孤立转移组患者83例．无转移组患者197例。孤立转移组和无转移组术后5年生存率分别为623％和83．5％．差异有统计学意义（P〈0．05）。孤立性淋巴结转移是影响本组患者预后的独立因素之一（P〈0．01）。肿瘤浸润深度是胃癌孤立性淋巴结转移的独立危险因素（P〈0．05）。孤立转移组中跳跃性淋巴结转移者19例（22．9％），跳跃性与非跳跃性淋巴结转移患者术后5年生存率分别为50．0％和66．1％．差异无统计学意义（P〉0．05）。结论发生孤立性淋巴结转移的胃癌患者预后较无淋巴结转移者差。施行D2根治术有助于跳跃性淋巴结转移的清扫．

Objective To investigate the impact of solitary lymph node （LN） metastasis on the prognosis of gastric cancer. Methods Clinical data of 280 patients with gastric cancer who underwent D2 radical resection from January 1995 to December 2003 were analyzed retrospectively. Among them, solitary LN metastasis was proven pathologically in 83 cases（solitary LN metastasis group）, while node- negative metastasis proven in 197 cases （node-negative group）. The 5-year survival rate was compared between two groups and between patients with and without skipping LN metastasis. The prognostic factors were evaluated by univaria and multivaria analyses. Results The 5-year survival rates in the solitary LN metastasis group and the node-negative group were 62.3% and 83.5% respectively with significant difference （P〈0.05）. The solitary LN metastasis was one of the independent prognostic factors. Logistic regression revealed that the invasion depth was an independent eovariate for solitary LN metastasis. The proportion of skip metastasis was 22.9% in gastric cancer patients with solitary LN metastasis. The 5- year survival rates of the patients with and without skipping LN metastasis were 50.0% and 66.1% respectively, which was not significantly different （P〉0.05）. Conclusions The prognosis of patients with solitary LN metastasis is significantly poorer than those without lymph node metastasis. Due to the high incidence of skip LN metastasis in gastric cancer, D2 radical resection should be performed to ensure oncological clearance.