103例进展期近端胃癌淋巴结转移的临床特点

Clinical characteristics of 103 lymph node metastasis in advanced proximal gastric cancer

目的 探讨进展期近端胃癌（PGC）淋巴结转移的临床特点,为制定合理的治疗方案提供临床依据.方法 回顾性分析2001年9月至2005年12月间天津医科大学附属肿瘤医院收治的103例行胃癌根治术或扩大根治术的PGC患者的临床资料,分析各站、组淋巴结的转移率及其影响因素.结果 本组PGC患者淋巴结转移率为78.6%;各站、组淋巴结转移率为：第1站70.8%.频率由高到低依次为No.3、No.1、No.2和4Sa、4Sb组淋巴结;第2站38.3%,频率依次为No.7、No.10、No.9、No.11、No.8a和No.4d组淋巴结;第3站及远处淋巴结22.3%.频率依次为No.5、No.6、No.16和No.12组淋巴结.Ordinal Logistic多因素分析表明：分化程度、肿瘤大小、浸润深度、有无远处转移是影响进展期PGC淋巴结转移的独立危险因素.结论 进展期PGC患者其淋巴结转移的数量可能与肿瘤分化程度、大小、浸润深度、有无远处转移密切相关,应根据其淋巴结转移风险选择合适的淋巴结清扫范围.

Objective To explore the pattern of lymph node metastasis（LNM）in advanced proximal gastric cancer in order to guide lymphadenectomy.Methods Between September 2001 and December 2005.a total of 103 patients with advanced proximal gastric cancer underwent radical gastrectomy with D2 or〉D2 lymphadenectomy.The clinical characteristics,pathologic features, and LNM were analyzed by univariate and multivariate analysis. esults LNM was observed in 81 of 103 cases（78.6%）.The LNM was identified in 70.8% at N1,38.3% at N2,22.3% at N3.LNM frequency was found in groups No.3,No.1,No.2 and No.4Sa,4Sb（from the highest to the lowest）at N1,groups No.7,No.10,No.9,No.11,No.8a and No.4d at N2,and groups No.5,No.6,No.16 and No.12 at N3.Ordinal Logistic regression analysis showed that histopathological type,tumor size,depth of invasion,and distant metastasis were independent factors for lymph node metastasis in advanced proximal gastric cancer.Conclusions The number of lymph node metastasis in advanced proximal gastric cancer is mainly associated with differentiation,tumor size,depth,of invasion,and distant metastasis.It is essential to dissect the lymph nodes according to the risk of lymph node metastasis.