早期胃癌临床病理学特征与预后的关系

Relationship between the clinicopathological features and prognosis in patients with early gastric cancer

目的:探讨和总结早期胃癌的临床病理学特征及其与病人预后间的关系,分析早期胃癌的淋巴结转移规律,为微创治疗、缩小手术提供依据。方法:采用单因素及多因素的分析法,回顾分析2003年1月至2008年9月仁济医院普外科接受手术治疗的231例早期胃癌病人的临床及病理学资料。结果:单因素分析显示,肿瘤大小、浸润深度及淋巴结转移程度与早期胃癌的预后相关;多因素分析提示,淋巴结转移是早期胃癌预后的独立性危险因素。单发早期胃癌的淋巴结转移率为15.6%(36/231),黏膜内癌淋巴结转移率为5.7%(4/70),黏膜下癌淋巴结转移率为19.9%(32/161)。Logistic回归分析提示,肿瘤直径>2 cm(P=0.038,OR=1.351)和肿瘤浸润至黏膜下层(P=0.027,OR=3.635)是淋巴结转移的独立危险因子。本研究中,无淋巴结转移的早期胃癌病人,其术后3年生存率为98.6%,显著优于有淋巴结转移者(P<0.05);其中有1～3枚淋巴结转移者,术后3年生存率为95.0%;有4枚及以上淋巴结转移者,术后3年生存率仅为44.4%。血行转移是早期胃癌病人术后复发的另一主要途径。结论:淋巴结转移是影响早期胃癌预后的重要指标,肿瘤直径>2 cm、肿瘤浸润至黏膜下层是早期胃癌淋巴结转移的独立危险因子;术前应用影像学技术评估早期胃癌淋巴结转移情况有助于选择合理的治疗方案。

Objective To discuss the relationship between the clinicopathological features and prognosis of early gastric cancer cases,and to analyze the status of lymph node metastasis in patients with early gastric cancer,so as to provide the basis for the application of minimally invasive therapy and reducing rationally the scale of surgical procedures.Methods The clinicopathological data of 231 EGC cases submitted to radical resection from Jan 2003 to Sep 2008 were analyzed retrospectively.Univariate and multivariate analysis were used to study the relationship between the clinicopathological features and the outcome of the patients.Results Univariate analysis showed that the prognosis of early gastric cancer was related to the tumor size,depth of invasion and status of lymph node metastasis.Multivariate analysis showed that the status of lymph node matastasis was the only independent prognostic factor.The incidence of lymph node metastasis in primary early gastric cancer was（36/231,15.6%）,that of the intramucosal invasive gastric cancer was（4/70,5.7%）,while in cases in which the the submucosa were involved was（32/161,19.9%）.Logistic regression analysis showed that tumor size over 2 cm and infiltration into the submucosa were the risk factors of the lymph node metastasis.In patients with early gastric cancer and no lymph node metastasis,the survival rate 3 years after surgery was 98.6%,significantly better than those with lymph node metastasis（P0.05）.In patients with 1～3 positive lymph nodes,their survival rate 3 years after surgery was 95.0%,and in patients with 4 positive lymph nodes,their survival 3 years after surgery was only 44.4%.Hematogenous metastasis was another main postoperative recurrent approach for early gastric cancer cases.Conclusions The status of lymph node metastasis is the key indicator of the prognosis of early gastric cancer;tumor size（ 2 cm） and infiltration into the submucosa are the independent risk factors to the status of lymph node metastasis in early gastric cancer.Pre-operative usage of the imaging technology would be a valuable means to predict the status of lymph node metastasis and to help designing an appropriate therapeutic strategy.