影响早期胃癌预后因素的分析

Biologic characters of tumor and gastric cancer prognosis

[目的]通过对早期胃癌(early gastric cancer,EGC)患者临床资料的研究,探讨EGC淋巴结转移与临床病理特征的关系,找出影响预后因素,以指导临床规范化外科治疗。[方法]回顾性分析EGC手术的338例患者的临床资料,分析淋巴结转移与肿瘤大小、组织学类型、浸润深度,大体分型之间的关系;应用Kaplan-Meier法对随访患者资料的预后因素进行生存率分析。[结果](1)Dl淋巴结清扫术139例(41.1%),D2淋巴结清扫术183例(54.1%),D3淋巴结清扫术16例(4.7%)。淋巴结转移与肿瘤大小、浸润深度有关,差异有显著性意义(P<0.05)。(2)63例随访患者总5年生存率92.1%;黏膜内癌5年生存率97.1%,黏膜下癌5年生存率85.7%;肿瘤大小、浸润深度、淋巴结转移与EGC术后生存率相关(P值分别为0.043、0.004)。[结论]根据肿瘤大小、浸润深度、淋巴结转移等生物学特点,合理选择手术方案,有助于提高5年生存率,改善预后。

[Objective] By studying the clinical data of 338 patients with early gastric cancer（EGC）,who had been performed radical resection upon.The lymph node metastasis rules and distribution were analyzed to find out the relationship between lymph node metastasis and clinical pathological specificity,the prognostic factors for the purpose of improving suvival of EGC patients and quality of life,in order to guide the surgical treatment of clinical standardization.[Methods] To review clinical data of the 338 patients and analyze the possible relationship of lymphnode metastasis,the size of tumor,types of histopathology,depth of infiltration,gross classification.Kaplan-Meier method was used to process suvival rate.[Results]（1） One hundred and thirty-nine patients（41.1%） had D1 radical lymphatic node dissection,183 patients（54.1%） had D2radical lymphatic node dissection,and other 16 （4.7%） had D3 radical lymphatic node dissection.It was found that lymph node metastasis was affected by the size of tumor and depth of infiltration（P0.05）.（2） General 5-year survival rate in a ll of the patients was 92.1%,5-year survival rate in the patients with intramucosa tumor was 97.1% and 5-year survival rate in the patients with submucosa tumor was 85.7%.The survival rate of EGC was related with invasion depth and lymph node metastasis（P=0.043 and 0.004）.[Conclusion] By estimating depth of infiltration,the size of tumor and the state of lymph node metastasis,right surgical protocol could be decided in order to improve survival rate and prognosis.