淋巴结清扫数目对无淋巴结转移胃癌患者预后的影响

Effect of number of resected lymph nodes on the prognosis of gastric cancer patients without lymphatic metastasis

目的 探讨胃癌根治术中淋巴结清扫数目对无淋巴结转移患者预后的影响.方法 回顾性分析1995年1月至2004年12月期间221例施行D2根治术、术后经病理证实无淋巴结转移的胃癌患者的临床资料.对本组患者预后因素进行单因素及多因素分析,分析淋巴结清扫数目与术后5年生存率及术后并发症发生率的关系.结果 221例无淋巴结转移胃癌患者术后5年生存率为83.5%.淋巴结清扫数目是影响本组患者预后的独立因素之一.相同浸润深度患者的术后5年生存率有随淋巴结清扫数目的 增加而增高的趋势（P〈0.05）.淋巴结清扫数目pT1.2期≥15枚、pT3期≥20枚时,患者术后5年生存率较高（P〈0.05）.本组患者术后并发症发生率为10.8%,淋巴结清扫数目与术后并发症发生率的无显著相关性（P〉0.05）.结论 淋巴结清扫数目是无淋巴结转移胃癌患者的独立预后因素,应积极争取清扫足够的淋巴结,以提高疗效;合理的淋巴结清扫数目并不增加患者术后并发症的发生率.

Objective To investigate the long-term correlation between the number of resected lymph nodes （ LNs） and the prognosis of patients with node-negative gastric cancer. Methods From January 1995 to December 2004, 221 patients with gastric cancer underwent D2 radical resection and were proved with no nodal involvement The clinical records of the patients were analyzed retrospectively. The relationships of the dissected LNs number to 5-year survival rate and post-operative complication rate were analyzed respectively. Results The overall 5-year survival rate of this group was 83. 5%. The total number of dissected LNs was one independent prognostic factors in this group. Among patients with the same depth of tumor invasion, the more the number of dissected LNs, the better the survival would be （P 〈0.05）. The patients had better long-term survival outcomes with dissected LNs counts of more than 15 for cases with pT1-2 tumor, and more than 20 for cases with pT3 tumor. The post-operative complication rate was 10. 8% and it was not significantly correlated with the number of dissected lymph nodes （P 〉 0. 05）. Conclusions The number of dissected LNs is an independent prognostic predicting factor for lymph node-negative gastric cancer. Sufficient dissection of LNs is recommended to improve the patients＇ long-term survival. Suitable increment of dissected LNs count would not increase the post-operative complication rate.